Tissue Targeted Antigenic Activation of the Immune Response to Treat Cancers

ABSTRACT

The invention provides in part methods of treating cancers of a specific organ or tissue by administering a composition that is antigenically specific for one or more microbes that are pathogenic in the specific organ or tissue in which the cancer is situated. The formulations of the invention thereby facilitate activation of an immune response to a cancer in a particular tissue or organ. The compositions may for example include killed or attenuated microbial pathogens, such as whole killed bacterial cells, and may be administered at sites distant from the cancer, for example the skin. In some embodiments, microbial species of endogenous flora that are known to cause infection in the relevant organ or tissue may be used in the formulation of the antigenic compositions. In alternative embodiments, exogenous microbial pathogens that are known to cause infection in the relevant organ or tissue may be used in the formulation of the antigenic compositions. The administration of the immunogenic compositions may be repeated relatively frequently over a relatively long period of time. In embodiments for intradermal or subcutaneous injection, dosages may be adjusted so that injections reproduce a consistent, visible, delayed inflammatory immune reaction at the successive site or sites of administration.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a Continuation-in-Part application of U.S.application Ser. No. 12/234,569 filed on Sep. 19, 2008; whichapplication is: (I) a Continuation-in-Part application of U.S.application Ser. No. 11/553,972 filed on Oct. 27, 2006 now abandoned;which application is a Continuation-in-Part application of InternationalApplication Serial No. PCT/CA05/00812 filed on May 30, 2005; whichInternational application pursuant to 35 U.S.C. §119 (e), claimspriority to the filing date of United States Provisional PatentApplication Ser. No. 60/577,206 filed Jun. 7, 2004; and (II) aContinuation-in-Part application of International Application Serial No.PCT/CA07/01915 filed on Oct. 25, 2007. The disclosures of alll of theapplications listed in this paragraph [0001] are herein incorporated byreference.

FIELD OF THE INVENTION

In various aspects, the invention relates to immunological cancertherapies. In alternative embodiments, the invention provides methods offormulating antigenic microbial composition and methods of using theantigenic compositions to treat cancers.

BACKGROUND OF THE INVENTION

More than one in three people in the developed nations are diagnosedwith cancer. More than one in four die from it. Therapies for cancerhave primarily relied upon treatments such as surgery, chemotherapy, andradiation. These approaches however, while beneficial for some types andstages of cancer, have proved to be of limited efficacy in many commontypes and stages of cancers. For example, surgical treatment of a tumorrequires complete removal of cancerous tissue to prevent reoccurrence.Similarly, radiation therapy requires complete destruction of cancerouscells. This is difficult since, in theory, a single malignant cell canproliferate sufficiently to cause reoccurrence of the cancer. Also, bothsurgical treatment and radiation therapy are directed to localized areasof cancer, and are relatively ineffective when the cancer metastasizes.Often surgery or radiation or both are used in combination with systemicapproaches such as chemotherapy. Chemotherapy however has the problem ofnon-selectivity with the concomitant problem of deleterious sideeffects, as well as the possibility of the cancer cells developingresistance to the drugs.

The inherent shortcomings of chemotherapy have led to disparate effortsto recruit various aspects of the immune system to treat cancers. Asubset of this work relates to immunization with microbial vaccines.Although this approach has a relatively long history, as discussed inmore detail below, the field is a very confused mixture of sometimesintriguing successes mixed with many failures that together have failedto produce a cohesive therapeutic approach amenable to widespreadclinical adoption.

Alternative approaches for the treatment of cancers have includedtherapies that involve augmentation of immune system function such ascytokine therapy (e.g., recombinant interleukin 2 and gamma interferonfor kidney cancers), dendritic cell therapy, autologous tumor vaccinetherapy, genetically-altered vaccine therapy, lymphocyte therapy, andmicrobial vaccine therapies. Microbial vaccines have been used tovaccinate subjects against pathogens that are associated with cancer,such as the human papillomavirus. Immunostimulatory microbial vaccinesthat are not targeted to cancer-causing organisms, i.e., non-specificimmunostimulatory vaccines, such as pyrogenic vaccines, have a longclinical history that includes reports of successes and failures intreating a variety of cancers. For example, Coley's vaccine (acombination of Streptococcus pyogenes and Serratia marcescens) has beenreported to be helpful for the treatment of sarcomas, and lymphomas(Nauts H C, Fowler G A A, Bogato F H. A review of the influence ofbacterial infection and of bacterial products [Coley's toxins] onmalignant tumors in man. Acta Med Scand 1953; 145 [Suppl. 276]:5-103).Clinical trials have reportedly demonstrated the benefit of Coley'svaccine treatment for lymphoma and melanoma (Kempin S, Cirrincone C,Myers J et al: Combined modality therapy of advanced nodular lymphomas:the role of nonspecific immunotherapy [MBV] as an important determinantof response and survival. Proc Am Soc Clin Oncol 1983; 24:56; Kolmel KF, Vehmeyer K. Treatment of advanced malignant melanoma by a pyrogenicbacterial lysate: a pilot study. Onkologie 1991; 14:411-17).

It has been suggested that the effectiveness of some non-specificbacterial cancer vaccines is attributable to particular bacterialcomponents or products, such as bacterial DNA or endotoxin (LPS), orbecause they induce the expression of particular factors, such as tumornecrosis factor (TNF) or interleukin-12. A correspondingly broad rangeof physiological mechanisms have been ascribed to such treatments,ranging from generalized effects of fever to anti-angiogenic mechanisms.In accordance with these various principles, a wide variety of microbialvaccines have been tested as general immune stimulants for the treatmentof cancer. While most have shown negative results, a few have shown someintruiguing positive results in certain contexts, as follows:

Intradermal BCG (Mycobacterium bovis) vaccine treatment has beenreported to be effective for the treatment of stomach cancer (Ochiai T,Sato J, Hayashi R, et al: Postoperative adjuvant immunotherapy ofgastric cancer with BCG-cell wall endoskeleton. Three- to six-yearfollow-up of a randomized clinical trial. Cancer Immunol Immunother1983; 14:167-171) and colon cancer (Smith R E, Colangelo L, Wieand H S,Begovic M, Wolmark N. Randomized trial of adjuvant therapy in coloncarcinoma: 10-Year results of NSABP protocol C-01. J. NCI-2004;96[15]:1128-32; Uyl-de Groot C A, Vermorken J B, Hanna M G, Verboon P,Groot M T, Bonsel G J, Meijer C J, Pinedo H M. Immunotherapy withautologous tumor cell-BCG vaccine in patients with colon cancer: aprospective study of medical and economic benefits Vaccine 2005;23[17-18]:2379-87).

Mycobacterium w vaccine therapy, in combination with chemotherapy andradiation, was found to significantly improve quality of life andresponse to treatment in patients with lung cancer (Sur P, Dastidar A.Role of Mycobacterium w as adjuvant treatment of lung cancer [non-smallcell lung cancer]. J Indian Med Assoc 2003 February; 101[2]:118-120).Similarly, Mycobacterium vaccae vaccine therapy was found to improvequality of life (O'Brien M, Anderson H, Kaukel E, et al. SRL172 [killedMycobacterium vaccae] in addition to standard chemotherapy improvesquality of life without affecting survival, in patients with advancednon-small-cell lung cancer: phase III results. Ann Oncol 2004 June;15[6]; 906-14) and symptom control (Harper-Wynne C, Sumpter K, Ryan C,et al. Addition of SRL 172 to standard chemotherapy in small cell lungcancer [SCLC] improves symptom control. Lung Cancer 2005 February;47[2]:289-90) in lung cancer patients.

Corynebacterium parvum vaccine was linked with a trend towards improvedsurvival for the treatment of melanoma (Balch C M, Smalley R V,Bartolucci A A, et al. A randomized prospective trial of adjuvant C.parvum immunotherapy in 260 patients with clinically localized melanoma[stage I]. Cancer 1982 Mar. 15; 49[6]:1079-84).

Intradermal Streptococcus pyogenes vaccine therapy was found to beeffective for the treatment of stomach cancer (Hanaue H, Kim D Y,Machimura T, et al. Hemolytic streptococcus preparation OK-432;beneficial adjuvant therapy in recurrent gastric carcinoma. Tokai J ExpClin Med 1987 November; 12[4]:209-14).

Nocardia rubra vaccine was found to be effective for the treatment oflung cancer (Yasumoto K, Yamamura Y. Randomized clinical trial ofnon-specific immunotherapy with cell-wall skeleton of Nocardia rubra.Biomed Pharmacother 1984; 38[1]:48-54; Ogura T. Immunotherapy ofrespectable lung cancer using Nocardia rubra cell wall skeleton. Gan ToKagaku Ryoho 1983 February; 10[2 Pt 2]:366-72) and linked to a trend toimproved survival for the treatment acute myelogenous leukemia (Ohno R,Nakamura H, Kodera Y, et al. Randomized controlled study ofchemoimmunotherapy of acute myelogenous leukemia [AML] in adults withNocardia rubra cell-wall skeleton and irradiated allogeneic AML cells.Cancer 1986 Apr. 15; 57[8]:1483-8).

Lactobacillus casei vaccine treatment combined with radiation was foundto more effective for the treatment of cervical cancer than radiationalone. (Okawa T, Kita M, Arai T, et al. Phase II randomized clinicaltrial of LC9018 concurrently used with radiation in the treatment ofcarcinoma of the uterine cervix. Its effect on tumor reduction andhistology. Cancer 1989 Nov. 1; 64[9]:1769-76)

Pseudomonas aeruginosa vaccine treatment was found to increase theeffectiveness of chemotherapy in the treatment of lymphoma and lungcancer (Li Z, Hao D, Zhang H, Ren L, et al. A clinical study on PA_MSHAvaccine used for adjuvant therapy of lymphoma and lung cancer. Hua Xi YiKe Da Xue Xue Bao September; 31 [3]:334-7).

Childhood vaccination with the smallpox vaccine (i.e., Vaccinia virusvaccine) was found to be associated with a decreased risk of melanomalater in life (Pfahlberg A, Kolmel K F, Grange J M. et al. Inverseassociation between melanoma and previous vaccinations againsttuberculosis and smallpox: results of the FEBIM study. J Invest Dermatol2002[119]:570-575) as well as decreased mortality in those patients whodid develop melanoma (Kolmel K F, Grange J M, Krone B, et al. Priorimmunization of patients with malignant melanoma with vaccinia or BCG isassociated with better survival. European Organization for Research andTreatment of Cancer cohort study on 542 patients. Eur J Cancer41[2005]:118-125).

Treatment with rabies virus vaccine was found to result in temporaryremission in 8 of 30 patients with melanoma (Higgins G, Pack G. Virustherapy in the treatment of tumors. Bull Hosp Joint Dis 1951;12:379-382; Pack G. Note on the experimental use of rabies vaccine formelanomatosis. Arch Dermatol 1950; 62:694-695).

In spite of substantial efforts to engage the immune system to combatcancers using non-specific immunostimulatory microbial vaccines, thevast majority of these efforts have failed and there is little clinicalor research evidence of widespread success in improving the survival ofcancer patient populations. While it has been recognized thatimmunostimulatory microbial vaccine approaches have promise, it has alsobeen recognized that significant challenges characterize the field (RalfKleef, Mary Ann Richardson, Nancy Russell, Cristina Ramirez. “Endotoxinand Exotoxin Induced Tumor Regression with Special Reference to ColeyToxins: A Survey of the Literature and Possible ImmunologicalMechanisms.” Report to the National Cancer Institute Office ofAlternative and Complementary Medicine August 1997; DL Mager. “Bacteriaand Cancer: Cause, Coincidence or Cure? A Review.” Journal ofTranslational Medicine 28 Mar. 2006 4[14]:doi:10.1186/1479-5876-4-14).There remains a need for alternative approaches to the formulation,administration and methodology of antigenic compositions for thetreatment of cancer.

SUMMARY OF THE INVENTION

In one aspect, the invention provides methods for formulating animmunogenic composition for treating a cancer situated in a specificorgan or tissue in a mammal, such as human patient. The method mayinclude selecting at least one microbial pathogen that is naturallypathogenic in the organ or tissue of the mammal within which the canceris situated. An antigenic composition may be produced that includesantigenic determinants that together are specific for or characteristicof the microbial pathogen.

A diagnostic step may be used to identify the specific organ or tissuewithin which the cancer is situated, prior to producing the antigeniccomposition targeted to the site of the cancer. The site of the cancermay be a primary site, or a secondary site of metastasis. The antigeniccomposition may be sufficiently specific that it would be capable ofeliciting an immune response in the mammal specific to the microbialpathogen. The antigenic composition may be a bacterial composition, forexample derived from a bacterial species or species that are endogenousto the flora of the patient or from an exogenous species or species. Inalternative embodiments, the antigenic composition may be derived from avirus or viruses. Accordingly, the microbial pathogen from which theantigenic composition is derived may be a virus. The microbial pathogenmay be killed. In alternative embodiments, the microbial pathogen may belive or attenuated. Immunogenic compositions of the invention may alsobe formulated or administered with anti-inflammatory modalities, such asan NSAID. The site of administration may be at a site distant from thesite of the cancer, for example in an organ or tissue that is not theorgan or tissue within which the cancer is situated, for example theskin or subcutaneous tissue.

The antigenic composition may for example be formulated for subcutaneousinjection, intradermal injection or oral administration. In embodimentsfor subcutaneous or intradermal injection, the dosing or formulation ofthe antigenic composition may be adjusted in order to produce alocalized immune reaction visible in the skin at the site ofadministration, for example an area of inflammation from 2 mm to 100 mmin diameter appearing, for example, 2-48 hours after administration andlasting, for example, 2-72 hours or longer. The antigenic compositionmay be formulated for repeated subcutaneous or intradermaladministration, for example at alternating successive sites.

In some embodiments, the invention involves methods of treating a mammalfor a cancer situated in a tissue or an organ. In alternativeembodiments, the treatment may anticipate the development of the cancerin the tissue, for example if the site of a primary tumour suggests thelikelihood of metastasis to a particular tissue or organ, then thepatient may be prophylactically treated to prevent or amelioratemetastasis to that tissue or organ. The method may include administeringto the subject an effective amount of an antigenic compositioncomprising antigenic determinants that together are specific for atleast one microbial pathogen. An aspect of the invention involves theuse of a microbial pathogen that is pathogenic in the specific organ ortissue of the mammal within which the cancer is situated. The antigeniccomposition may be administered, for example by subcutaneous orintradermal injection at an administration site, in successive dosesgiven at a dosage interval, for example of between one hour and onemonth, over a dosage duration, for example of at least 2 weeks, 2months, 6 months, 1, 2, 3, 4, or 5 years or longer. Each injection dosemay for example be metered so that it is effective to cause visiblelocalized inflammation at the administration site, appearing, forexample, 2-48 hours after injection.

The invention provides in part methods of treating cancers of a specificorgan or tissue in a subject by administering one or more antigens ofone or more microbial pathogens, such as bacterial or viral species thatare pathogenic in the specific organ or tissue.

In alternative embodiments, the pathogenic microbial species may becapable of causing infection naturally, (i.e., without humanintervention) in the specific organ or tissue in a healthy subject, ormay have caused an infection in the specific organ or tissue in ahealthy subject. In alternative embodiments, the antigen may beadministered by administering a whole microbial species. In alternativeembodiments, the method may for example include administering at leasttwo or more microbial species, or administering at least three or moremicrobial species, and the microbes may be bacteria or viruses. Inalternative embodiments, the method may further include administering asupplement or an adjuvant. An aspect of the invention involvesadministering antigenic compositions so as to elicit an immune responsein said subject.

In alternative embodiments, the microbial pathogen in the antigeniccomposition may be killed, and thus rendered non-infectious. In someembodiments, the antigenic composition is administered at a site distantfrom the cancer site, and in selected embodiments of this kind, methodsof the invention may be carried out so that they do not produceinfection at the cancer site.

A “cancer” or “neoplasm,” as used herein, is any unwanted growth ofcells serving no physiological function. In general, a cancer cell hasbeen released from its normal cell division control, i.e., a cell whosegrowth is not regulated by the ordinary biochemical and physicalinfluences in the cellular environment. Thus, “cancer” is a general termfor diseases characterized by abnormal uncontrolled cell growth. In mostcases, a cancer cell proliferates to form clonal cells that aremalignant. The lump or cell mass, “neoplasm” or “tumor,” is generallycapable of invading and destroying surrounding normal tissues. By“malignancy” is meant an abnormal growth of any cell type or tissue thathas a deleterious effect in the organism having the abnormal growth. Theterm “malignancy” or “cancer” includes cell growths that are technicallybenign but which carry the risk of becoming malignant. Cancer cells mayspread from their original site to other parts of the body through thelymphatic system or blood stream in a process known as “metastasis.”Many cancers are refractory to treatment and prove fatal. Examples ofcancers or neoplasms include, without limitation, transformed andimmortalized cells, tumors, carcinomas, in various organs and tissues asdescribed herein or known to those of skill in the art.

A “cell” is the basic structural and functional unit of a livingorganism. In higher organisms, e.g., animals, cells having similarstructure and function generally aggregate into “tissues” that performparticular functions. Thus, a tissue includes a collection of similarcells and surrounding intercellular substances, e.g., epithelial tissue,connective tissue, muscle, nerve. An “organ” is a fully differentiatedstructural and functional unit in a higher organism that may be composedof different types of tissues and is specialized for some particularfunction, e.g., kidney, heart, brain, liver, etc. Accordingly, by“specific organ, tissue, or cell” is meant herein to include anyparticular organ, and to include the cells and tissues found in thatorgan.

“Pathogenic” agents are agents, such as microbes, such as bacteria orviruses, that are known to cause infection in a host in nature, and inthis sense, “pathogenic” is used in the context of the present inventionto mean “naturally pathogenic”. Although a wide variety of microbes maybe capable of causing infection under artificial conditions, such asartificial innoculations of a microbe into a tissue, the range ofmicrobes that naturally cause infection is necessarily limited, and wellestablished by medical practice.

An “infection” is the state or condition in which the body or a part ofit is invaded by a pathogenic agent (e.g., a microbe, such as abacterium) which, under favorable conditions, multiplies and produceseffects that are injurious (Taber's Cyclopedic Medical Dictionary, 14thEd., C. L. Thomas, Ed., F. A. Davis Company, PA, USA). An infection maynot always be apparent clinically and may result in only localizedcellular injury. Infections may remain subclinical, and temporary if thebody's defensive mechanisms are effective. Infections may spread locallyto become clinically apparent as an acute, a subacute, or a chronicclinical infection or disease state. A local infection may also becomesystemic when the pathogenic agent gains access to the lymphatic orvascular system (On-Line Medical Dictionary,http://cancerweb.ncl.ac.uk/omd/). Infection is usually accompanied byinflammation, but inflammation may occur without infection.

“Inflammation” is the characteristic tissue reaction to injury (markedby swelling, redness, heat, and pain), and includes the successivechanges that occur in living tissue when it is injured. Infection andinflammation are different conditions, although one may arise from theother (Taber's Cyclopedic Medical Dictionary, supra). Accordingly,inflammation may occur without infection and infection may occur withoutinflammation (although inflammation typically results from infection bypathogenic bacteria or viruses).

Inflammation is characterized by the following symptoms: redness(rubor), heat (calor), swelling (tumor), pain (dolor). Localized visibleinflammation on the skin may be apparent from a combination of thesesymptoms, particularly redness at a site of administration.

Various subjects may be treated in accordance with alternative aspectsof the invention. A “subject” is an animal, e.g, a mammal, to whom thespecific pathogenic bacteria, bacterial antigens, viruses, viralantigens or compositions thereof of the invention may be administered.Accordingly, a subject may be a patient, e.g., a human, suffering from acancer, or suspected of having a cancer, or at risk for developing acancer. A subject may also be an experimental animal, e.g., an animalmodel of a cancer, as is described in Example 5. In some embodiments,the terms “subject” and “patient” may be used interchangeably, and mayinclude a human, a non-human mammal, a non-human primate, a rat, mouse,dog, etc. A healthy subject may be a human who is not suffering from acancer or suspected of having a cancer, or who is not suffering from achronic disorder or condition. A “healthy subject” may also be a subjectwho is not immunocompromised. By immunocompromised is meant anycondition in which the immune system functions in an abnormal orincomplete manner. Immunocompromisation may be due to disease, certainmedications, or conditions present at birth. Immunocompromised subjectsmay be found more frequently among infants, the elderly, and individualsundergoing extensive drug or radiation therapy.

An “immune response” includes, but is not limited to, one or more of thefollowing responses in a mammal: induction or activation of antibodies,neutrophils, monocytes, macrophages, B cells, T cells (including helperT cells, natural killer cells, cytotoxic T cells, γδ T cells), such asinduction or activation by the antigen(s) in a composition or vaccine,following administration of the composition or vaccine. An immuneresponse to a composition or vaccine thus generally includes thedevelopment in the host animal of a cellular and/or antibody-mediatedresponse to the composition or vaccine of interest. In some embodiments,the immune response is such that it will also result in slowing orstopping the progression of a cancer in the animal.

Various aspects of the invention involve treating cancers. In thiscontext, treatment may be carried out so as to provide a variety ofoutcomes. For example, treatment may: provoke an immune reaction that iseffective to inhibit or ameliorate the growth or proliferation of acancer; inhibit the growth or proliferation of cancer cells or tumors;cause remission of a cancer; improve quality of life; reduce the risk ofrecurrence of a cancer; inhibit metastasis of a cancer; or, improvepatient survival rates in a patient population. In this context,extending the life expectancy of a patient, or patient population, meansto increase the number of patients who survive for a given period oftime following a particular diagnosis. In some embodiments, treatmentmay be of patients who have not responded to other treatments, such aspatients for whom a chemotherapy or surgery has not been an effectivetreatment. Treatment in alternative embodiments may for example bebefore or after onset of cancer. For example prophylactic treatment maybe undertaken, for example of patients diagnosed as being at risk of aparticular cancer. For example a patient having a genetic or lifestylepredisposition to cancer of a certain tissue or organ may be treatedwith an immunogenic composition comprising antigenic determinants of apathogen that is pathogenic in that organ or tissue. Similarly, theprophylactic treatment of metastasis may be undertaken, so that patientshaving a primary cancer with a propensity to metastasize to a particulartissue or organ may be treated with an immunogenic compositioncomprising antigenic determinants of a pathogen that is pathogenic inthat organ or tissue.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a survival curve for a cumulative series of patientsdiagnosed with stage 3B or 4 inoperable lung cancer (all patients),comparing patients treated with MRV, patients not treated with the MRV,and a standard SEER survival curve.

FIG. 2 shows a survival curve for a cumulative series of patientsdiagnosed with stage 3B or 4 inoperable lung cancer (patients treatedfor at least 2 months with MRV), comparing patients treated with MRV,patients not treated with the MRV, and a standard SEER survival curve.

FIG. 3 shows a survival curve for a cumulative series of patientsdiagnosed with stage 3B or 4 lung cancer, illustrating the benefits oftreatment with the MRV composition of the invention, comparing patientstreated with MRV, patients not treated with the MRV, and a standard SEERsurvival curve.

FIG. 4 shows a survival curve for a cumulative series of patientsdiagnosed with stage 3B or 4 lung cancer, illustrating the effect oftreatments for at least 2 months, comparing patients treated with MRV,patients not treated with the MRV, and a standard SEER survival curve.

FIG. 5 shows a survival curve for a cumulative series of patientsdiagnosed with stage 3B or 4 lung cancer, illustrating the effect oftreatments for at least 6 months duration, comparing patients treatedwith MRV, patients not treated with the MRV, and a standard SEERsurvival curve.

FIG. 6 shows a survival curve for a cumulative series of 52 breastcancer patients with metastases to bone and/or lung, comparing patientstreated with MRV, patients not treated with the MRV, and a standard SEERsurvival curve.

FIG. 7 is a comparison of survival of a cumulative series of metastaticprostate cancer patients who had surgery or radiation to destroy theirprostate gland (and thus, the primary tumour) and who had detectablecancer limited to bone metastases, comparing patients treated with MRV,patients not treated with the MRV, and a standard SEER survival curve.

FIG. 8 shows a survival curve for a cumulative series of patientsinitially diagnosed with Stage 4 colorectal cancer, comparing patientstreated with PVF, patients treated with MRV, patients not treated withan antigenic composition and a standard SEER survival curve.

FIG. 9 shows a survival curve for a cumulative series of patientsinitially diagnosed with Stage 4 Colorectal Cancer, with date frompatients receiving treatment within 3 months of diagnosis, comparingpatients treated with PVF, patients treated with MRV, patients nottreated with an antigenic composition and a standard SEER survivalcurve.

FIG. 10 shows a survival curve for a cumulative series of stage 3B lungcancer patients who were treated with an oral antigen therapy, Respivax,compared to patients who did not use an antigenic composition.

FIG. 11 shows a survival curve for a cumulative series of patientsdiagnosed with stage 3B lung cancer, illustrating the benefits oftreatment with the MRV composition of the invention, comparing patientstreated with MRV, patients not treated with the MRV, and a standard SEERsurvival curve.

FIG. 12 shows a survival curve measured from date of first visit for acumulative series of patients diagnosed with stage 3B lung cancer,illustrating the benefits of treatment with the MRV composition of theinvention, comparing patients treated with MRV, patients not treatedwith the MRV, and a standard SEER survival curve.

FIG. 13 shows a survival curve for a cumulative series of patientsdiagnosed with stage 3B lung cancer whose first visit was within 3months of diagnosis, illustrating the benefits of early treatment withthe MRV composition of the invention, comparing patients treated withMRV and patients not treated with the MRV.

FIG. 14 shows a photograph of lungs from mice treated (row 1) andnot-treated (row 2) with K. pneumoniae cells-only vaccine followingchallenge with Lewis lung carcinoma cells, as described in Example 4Aherein. The bottom row (not-numbered) depicts lungs from mice that werenot exposed to the mouse model of lung cancer.

FIG. 15 shows the average tumor volume of mice treated [AB1-AB6] andnot-treated [AB-7] with bacterial vaccines following challenge with B16melanoma cells, as described in Example 4B herein.

FIG. 16 shows a survival curve of colon cancer model mouse groupstreated with or without a variety of bacterial vaccines, as described inExample 4C herein.

FIG. 17 shows the number of inflammatory monocytes and dendritic cellsin the draining lymph node, lungs, and spleen following treatment witheither a K. pneumoniae antigenic composition or PBS, as described inExample 5A herein.

FIG. 18 shows the total number of monocytes and dendritic cells in thelung, peritoneum and spleen of mice following treatment with either a K.pneumoniae antigenic composition, an E. coli antigenic composition, orPBS, as described in Example 5B herein.

FIG. 19 shows the total number of CD4+ T cells, CD8+ T cells, and NKcells from mice treated with either a K. pneumoniae antigeniccomposition, an E. coli antigenic composition, or PBS, as described inExample 5B herein.

FIG. 20 shows the total number of (A) inflammatory monocytes and (B)CD4+ T cells, CD8+ T cells, and NK cells on either of day 9 or 16 frommice treated with either heat-inactivated a K. pneumoniae antigeniccomposition, a phenol-inactivated K. pneumoniae antigenic composition,or PBS, as described in Example 5C herein.

FIG. 21 shows the total number of (A) inflammatory monocytes anddendritic cells and (B) CD4+ T cells, CD8+ T cells, and NK cells frommice treated with either a heat-inactivated K. pneumoniae antigeniccomposition, a phenol-inactivated K. pneumoniae antigenic composition,or PBS, as described in Example 5D herein.

DETAILED DESCRIPTION OF THE INVENTION

In various aspects, the invention relates to the surprising discoverythat administration, for example at a site distant from the cancer, ofmicrobial pathogens, such as killed microbial pathogens, that arepathogenic in a particular tissue or organ is effective in treatingcancer situated in that specific tissue or organ. Accordingly, theinvention provides antigenic compositions derived from these microbialpathogens, including whole killed bacterial or viral species, orcomponents thereof, for the treatment of cancer, and methods for usingthe same.

Based on observations from treating patients, it was found thatadministering compositions of killed bacteria which included many of thebacterial species that commonly cause lung infection was surprisinglyand unexpectedly effective in improving the clinical course of cancer ofthe lung. Similarly, it was found that administering compositionsincluding killed Staphylococcus aureus, one of the most common causes ofbone, breast, skin, perineal and lymph node infection and septicemia wassurprising and unexpectedly effective in improving the clinical courseof cancer of the bone, breast, skin, perineum, and lymphoma (cancer ofthe lymph glands) and multiple myeloma (a type of hematological cancer).Similarly, it was surprisingly and unexpectedly found that administeringa composition including Escherichia coli, which is a common cause ofcolon, kidney, peritoneal, liver, abdominal, pancreatic and ovarianinfection, was effective in improving the clinical course of cancer inthe colon, kidney, peritoneum, liver, abdominal lymph nodes, pancreasand ovary.

These results indicate that a composition including antigens ofpathogenic microbial species that cause infection in a particular tissueor organ will be an effective formulation for treating a cancer in thattissue or organ. For example, cancer in the lung is effectively treatedwith a microbial composition including one or more pathogenic speciesthat commonly cause lung infection, while cancer in the colon iseffectively treated with a composition including pathogenic microbialspecies that commonly cause colon infections.

Antigenic compositions of the invention may be produced that includeantigenic determinants that together are specific for or characteristicof a microbial pathogen. In this context, by “specific”, it is meantthat the antigenic determinants are sufficiently characteristic of thepathogen that they could be used to raise an immune response, such as anadaptive immune response, against the pathogen in the patient, if theantigenic determinants were to be administered in an appropriate mannerto have that effect. It will be recognized that the antigenicdeterminants need not be so specific that they are characteristic ofonly one particular strain or species of pathogen, since even a specificimmune response against a particular pathogen may be cross reactive withother closely related organisms that are also naturally pathogenic inthe tissue or organ in which the cancer is situated and that theantigenic composition is formulated or selected to target.

In some embodiments, the compositions of pathogenic microbes may be usedfor treating primary cancer sites and/or sites of metastasis. Thus, forexample, the microbial compositions may be used for the treatment of acancer at a particular site, regardless of whether the cancer is aprimary cancer or a metastasis. The composition may be directed to thetreatment of each cancer site, or may be a combined composition for boththe primary cancer and the metastatic site(s). For example, to treatkidney cancer that has metastasized to the lung and bone, threedifferent compositions, including one or more species that are known tobe kidney pathogens, one or more species that are known to be lungpathogens and one or more species that are known to be bone pathogens,or a combined composition thereof may be used. In some embodiments, thecompositions may be administered in different locations at the same timeor at different times.

For example, for lung cancer with metastasis to the bone, in alternativeembodiments, both a microbial composition including one or morebacterial species (or viruses) which commonly cause lung infection and amicrobial composition including one or more bacterial species (orviruses) which commonly cause bone infection may be used. Similarly, forcolon cancer with metastasis to the lungs, both a pathogenic bacterial(or viral) composition including one or more bacterial species (orviruses) which commonly cause colon infection and a microbialcomposition including one or more bacterial species (or viruses) whichcommonly cause lung infection may be used; for prostate cancer withmetastasis to the bones, both a pathogenic bacterial (or viral)composition including one or more bacterial species (or viruses) whichcommonly cause prostate infection and a pathogenic bacterial (or viral)composition including one or more bacterial species (or viruses) thatcommonly cause bone infection may be used.

The following list provides some non-limiting examples of primarycancers and their common sites for secondary spread (metastases):

Primary cancer Common sites for metastases prostate bone, lungs breastbone, lungs, skin, liver, brain lung bone, brain, liver, lungs colonliver, lungs, bone, brain kidney lungs, bone, brain pancreas liver,lungs melanoma lungs, skin, liver, brain uterus lungs, bones, ovariesovary liver, lung bladder bone, lung, liver head and neck bone, lungssarcoma lungs, brain stomach liver cervix bone, lungs testes lungsthyroid bone, lungs

In some embodiments, the antigenic compositions may be used for treatingor preventing cancers at primary sites or for treating or preventingmetastasis. For example, in long-term smokers, an antigenic compositionspecific for cancer of the lung (for example including antigenicdeterminants of one or more bacterial species or viruses which commonlycause lung infection) may be used to appropriately stimulate the immunesystem to defend against the development of cancer within the lungtissue. As another example, an antigenic composition specific for cancerof the breast (for example including antigenic determinants of one ormore bacterial species which commonly cause breast infection) could beused to prevent breast cancer in women with a strong family history ofbreast cancer or a genetic predisposition. In alternative embodiments,an antigenic composition including one or more bacterial species whichcommonly cause bone infection may be used to prevent or treat bonemetastases in a patient with prostate cancer. In further alternativeembodiments, an antigenic composition including one or more bacterialspecies or viruses which commonly cause lung infection may be used toprevent or treat lung metastases in a patient with malignant melanoma.

Various alternative embodiments and examples of the invention aredescribed herein. These embodiments and examples are illustrative andshould not be construed as limiting the scope of the invention.

Cancers

Most cancers fall within three broad histological classifications:carcinomas, which are the predominant cancers and are cancers ofepithelial cells or cells covering the external or internal surfaces oforgans, glands, or other body structures (e.g., skin, uterus, lung,breast, prostate, stomach, bowel), and which tend to metastasize;sarcomas, which are derived from connective or supportive tissue (e.g.,bone, cartilage, tendons, ligaments, fat, muscle); and hematologictumors, which are derived from bone marrow and lymphatic tissue.Carcinomas may be adenocarcinomas (which generally develop in organs orglands capable of secretion, such as breast, lung, colon, prostate orbladder) or may be squamous cell carcinomas (which originate in thesquamous epithelium and generally develop in most areas of the body).Sarcomas may be osteosarcomas or osteogenic sarcomas (bone),chondrosarcomas (cartilage), leiomyosarcomas (smooth muscle),rhabdomyosarcomas (skeletal muscle), mesothelial sarcomas ormesotheliomas (membranous lining of body cavities), fibrosarcomas(fibrous tissue), angiosarcomas or hemangioendotheliomas (bloodvessels), liposarcomas (adipose tissue), gliomas or astrocytomas(neurogenic connective tissue found in the brain), myxosarcomas(primitive embryonic connective tissue), or mesenchymous or mixedmesodermal tumors (mixed connective tissue types). Hematologic tumorsmay be myelomas, which originate in the plasma cells of bone marrow;leukemias which may be “liquid cancers” and are cancers of the bonemarrow and may be myelogenous or granulocytic leukemia (myeloid andgranulocytic white blood cells), lymphatic, lymphocytic, orlymphoblastic leukemias (lymphoid and lymphocytic blood cells) orpolycythemia vera or erythremia (various blood cell products, but withred cells predominating); or lymphomas, which may be solid tumors andwhich develop in the glands or nodes of the lymphatic system, and whichmay be Hodgkin or Non-Hodgkin lymphomas. In addition, mixed typecancers, such as adenosquamous carcinomas, mixed mesodermal tumors,carcinosarcomas, or teratocarcinomas also exist.

Cancers may also be named based on the organ in which they originatei.e., the “primary site,” for example, cancer of the breast, brain,lung, liver, skin, prostate, testicle, bladder, colon and rectum,cervix, uterus, etc. This naming persists even if the cancermetastasizes to another part of the body that is different from theprimary site. With the present invention, treatment is directed to thesite of the cancer, not type of cancer, so that a cancer of any typethat is situated in the lung, for example, would be treated on the basisof this localization in the lung.

Cancers named based on primary site may be correlated with histologicalclassifications. For example, lung cancers are generally small cell lungcancers or non-small cell lung cancers, which may be squamous cellcarcinoma, adenocarcinoma, or large cell carcinoma; skin cancers aregenerally basal cell cancers, squamous cell cancers, or melanomas.Lymphomas may arise in the lymph nodes associated with the head, neckand chest, as well as in the abdominal lymph nodes or in the axillary oringuinal lymph nodes. Identification and classification of types andstages of cancers may be performed by using for example informationprovided by the Surveillance, Epidemiology, and End Results (SEER)Program of the National Cancer Institute, which is an authoritativesource of information on cancer incidence and survival in the UnitedStates and is recognized around the world. The SEER Program currentlycollects and publishes cancer incidence and survival data from 14population-based cancer registries and three supplemental registriescovering approximately 26 percent of the US population. The programroutinely collects data on patient demographics, primary tumor site,morphology, stage at diagnosis, first course of treatment, and follow-upfor vital status, and is the only comprehensive source ofpopulation-based information in the United States that includes stage ofcancer at the time of diagnosis and survival rates within each stage.Information on more than 3 million in situ and invasive cancer cases isincluded in the SEER database, and approximately 170,000 new cases areadded each year within the SEER coverage areas. The incidence andsurvival data of the SEER Program may be used to access standardsurvival for a particular cancer site and stage. For example, to ensurean optimal comparison group, specific criteria may be selected from thedatabase, including date of diagnosis and exact stage (for example, inthe case of the lung cancer example herein, the years were selected tomatch the time-frame of the retrospective review, and stage 3B and 4lung cancer were selected; and in the case of the colon cancer exampleherein, the years were also selected to match the time-frame of theretrospective review, and the stage 4 colon cancer was selected).

Bacteria and Bacterial Colonizations and Infections

Most animals are colonized to some degree by other organisms, such asbacteria, which generally exist in symbiotic or commensal relationshipswith the host animal. Thus, many species of normally harmless bacteriaare found in healthy animals, and are usually localized to the surfaceof specific organs and tissues. Often, these bacteria aid in the normalfunctioning of the body. For example, in humans, symbiotic Escherichiacoli bacteria may be found in the intestine, where they promote immunityand reduce the risk of infection with more virulent pathogens.

Bacteria that are generally harmless, such as Escherichia coli, cancause infection in healthy subjects, with results ranging from mild tosevere infection to death. Whether or not a bacterium is pathogenic(i.e., causes infection) depends to some extent on factors such as theroute of entry and access to specific host cells, tissues, or organs;the intrinsic virulence of the bacterium; the amount of the bacteriapresent at the site of potential infection; or the health of the hostanimal. Thus, bacteria that are normally harmless can become pathogenicgiven favorable conditions for infection, and even the most virulentbacterium requires specific circumstances to cause infection.Accordingly, microbial species that are members of the normal flora canbe pathogens when they move beyond their normal ecological role in theendogenous flora. For example, endogenous species can cause infectionoutside of their ecological niche in regions of anatomical proximity,for example by contiguous spread. When this occurs, these normallyharmless endogenous bacteria are considered pathogenic.

Specific bacterial species and viruses are known to cause infections inspecific cells, tissues, or organs in otherwise healthy subjects.Examples of bacteria and viruses that commonly cause infections inspecific organs and tissues of the body are listed below; it will beunderstood that these examples are not intended to be limiting and thata skilled person would be able to readily recognize and identifyinfectious or pathogenic bacteria that cause infections, or commonlycause infections, in various organs and tissues in healthy adults (andrecognize the relative frequency of infection with each bacterialspecies) based on the knowledge in the field as represented, forexample, by the following publications: Manual of Clinical Microbiology8th Edition, Patrick Murray, Ed., 2003, ASM Press American Society forMicrobiology, Washington D.C., USA; Mandell, Douglas, and Bennett'sPrinciples and Practice of Infectious Diseases 5th Edition, G. L.Mandell, J. E. Bennett, R. Dolin, Eds., 2000, Churchill Livingstone,Philadelphia, Pa., USA, all of which are incorporated by referenceherein.

Infections of the skin are commonly caused by the following bacterialspecies: Staphylococcus aureus, Beta hemolytic streptococci group A, B,C or G, Corynebacterium diptheriae, Corynebacterium ulcerans, orPseudomonas aeruginosa; or viral pathogens: rubeola, rubella,varicella-zoster, echoviruses, coxsackieviruses, adenovirus, vaccinia,herpes simplex, or parvo B19.

Infections of the soft tissue (e.g., fat and muscle) are commonly causedby the following bacterial species: Streptococcus pyogenes,Staphylococcus aureus, Clostridium perfringens, or other Clostridiumspp.; or viral pathogens: influenza, or coxsackieviruses

Infections of the breast are commonly caused by the following bacterialspecies: Staphylococcus aureus, or Streptococcus pyogenes.

Infections of the lymph nodes of the head and neck are commonly causedby the following bacterial species: Staphylococcus aureus, orStreptococcus pyogenes; or viral pathogens: Epstein-Barr,cytomegalovirus, adenovirus, measles, rubella, herpes simplex,coxsackieviruses, or varicella-zoster.

Infections of the lymph nodes of the arm/axillae are commonly caused bythe following bacterial species: Staphylococcus aureus, or Streptococcuspyogenes; or viral pathogens: measles, rubella, Epstein-Barr,cytomegalovirus, adenovirus, or varicella-zoster.

Infections of the lymph nodes of the mediastinum are commonly caused bythe following bacterial species: viridans streptococci, Peptococcusspp., Peptostreptococcus spp., Bacteroides spp., Fusobacterium spp., orMycobacterium tuberculosis; or viral pathogens: measles, rubella,Epstein-Barr, cytomegalovirus, varicella-zoster, or adenovirus.

Infections of the pulmonary hilar lymph nodes are commonly caused by thefollowing bacterial species: Streptococcus pneumoniae, Moraxellacatarrhalis, Mycoplasma pneumoniae, Klebsiella pneumoniae, Haemophilusinfluenza, Chlamydophila pneumoniae, Bordetella pertussis orMycobacterium tuberculosis; or viral pathogens: influenza, adenovirus,rhinovirus, coronavirus, parainfluenza, respiratory syncytial virus,human metapneumovirus, or coxsackievirus.

Infections of the intra-abdominal lymph nodes are commonly caused by thefollowing bacterial species: Yersinia enterocolitica, Yersiniapseudotuberculosis, Salmonella spp., Streptococcus pyogenes, Escherichiacoli, Staphylococcus aureus, or Mycobacterium tuberculosis; or viralpathogens: measles, rubella, Epstein-Barr, cytomegalovirus,varicella-zoster, adenovirus, influenza, or coxsackievi ruses.

Infections of the lymph nodes of the leg/inguinal region are commonlycaused by the following bacterial species: Staphylococcus aureus, orStreptococcus pyogenes; or viral pathogens: measles, rubella,Epstein-Barr, cytomegalovirus, or herpes simplex.

Infections of the blood (i.e., septicemia) are commonly caused by thefollowing bacterial species: Staphylococcus aureus, Streptococcuspyogenes, coagulase-negative staphylococci, Enterococcus spp.,Escherichia coli, Klebsiella spp., Enterobacter spp., Proteus spp.,Pseudomonas aeruginosa, Bacteroides fragilis, Streptococcus pneumoniae,or group B streptococci; or viral pathogens: rubeola, rubella,varicella-zoster, echoviruses, coxsackieviruses, adenovirus,Epstein-Barr, herpes simplex, or cytomegalovirus.

Infections of the bone are commonly caused by the following bacterialspecies: Staphylococcus aureus, coagulase-negative staphylococci,Streptococcus pyogenes, Streptococcus pneumoniae, Streptococcusagalactiae, other streptococci spp., Escherichia coli, Pseudomonas spp.,Enterobacter spp., Proteus spp., or Serratia spp.; or viral pathogens:parvovirus B19, rubella, or hepatitis B.

Infections of the meninges are commonly caused by the followingbacterial species: Haemophilus influenzae, Neisseria meningitidis,Streptococcus pneumoniae, Streptococcus agalactiae, or Listeriamonocytogenes; or viral pathogens: echoviruses, coxsackieviruses, otherenteroviruses, or mumps.

Infections of the brain are commonly caused by the following bacterialspecies: Streptococcus spp. (including S. anginosus, S. constellatus, S.intermedius), Staphylococcus aureus, Bacteroides spp., Prevotella spp.,Proteus spp., Escherichia coli, Klebsiella spp., Pseudomonas spp.,Enterobacter spp., or Borrelia burgdorferi; or viral pathogens:coxsackieviruses, echoviruses, poliovirus, other enteroviruses, mumps,herpes simplex, varicella-zoster, flaviviruses, or bunyaviruses.

Infections of the spinal cord are commonly caused by the followingbacterial species: Haemophilus influenzae, Neisseria meningitidis,Streptococcus pneumoniae, Streptococcus agalactiae, Listeriamonocytogenes, or Borrelia burgdorferi; or viral pathogens:coxsackieviruses, echoviruses, poliovirus, other enteroviruses, mumps,herpes simplex, varicella-zoster, flaviviruses, or bunyaviruses.

Infections of the eye/orbit are commonly caused by the followingbacterial species: Staphylococcus aureus, Streptococcus pyogenes,Streptococcus pneumoniae, Streptococcus milleri, Escherichia coli,Bacillus cereus, Chlamydia trachomatis, Haemophilus influenza,Pseudomonas spp., Klebsiella spp., or Treponema pallidum; or viralpathogens: adenoviruses, herpes simplex, varicella-zoster, orcytomegalovirus.

Infections of the salivary glands are commonly caused by the followingbacterial species: Staphylococcus aureus, viridans streptococci (e.g.,Streptococcus salivarius, Streptococcus sanguis, Streptococcus mutans),Peptostreptococcus spp., or Bacteroides spp., or other oral anaerobes;or viral pathogens: mumps, influenza, enteroviruses, or rabies.

Infections of the mouth are commonly caused by the following bacterialspecies: Prevotella melaminogenicus, anaerobic streptococci, viridansstreptococci, Actinomyces spp., Peptostreptococcus spp., or Bacteroidesspp., or other oral anaerobes; or viral pathogens: herpes simplex,coxsackieviruses, or Epstein-Barr.

Infections of the tonsils are commonly caused by the following bacterialspecies: Streptococcus pyogenes, or Group C or G B-hemolyticstreptococci; or viral pathogens: rhinoviruses, influenza, coronavirus,adenovirus, parainfluenza, respiratory syncytial virus, or herpessimplex.

Infections of the sinuses are commonly caused by the following bacterialspecies: Streptococcus pneumoniae, Haemophilus influenza, Moraxellacatarrhalis, α-streptococci, anaerobic bacteria (e.g., Prevotella spp.),or Staphylococcus aureus; or viral pathogens: rhinoviruses, influenza,adenovirus, or parainfluenza.

Infections of the nasopharynx are commonly caused by the followingbacterial species: Streptococcus pyogenes, or Group C or G B-hemolyticstreptococci; or viral pathogens: rhinoviruses, influenza, coronavirus,adenovirus, parainfluenza, respiratory syncytial virus, or herpessimplex.

Infections of the thyroid are commonly caused by the following bacterialspecies: Staphylococcus aureus, Streptococcus pyogenes, or Streptococcuspneumoniae; or viral pathogens: mumps, or influenza.

Infections of the larynx are commonly caused by the following bacterialspecies: Mycoplasma pneumoniae, Chlamydophila pneumoniae, orStreptococcus pyogenes; or viral pathogens: rhinovirus, influenza,parainfluenza, adenovirus, corona virus, or human metapneumovirus.

Infections of the trachea are commonly caused by the following bacterialspecies: Mycoplasma pneumoniae; or viral pathogens: parainfluenza,influenza, respiratory syncytial virus, or adenovirus.

Infections of the bronchi are commonly caused by the following bacterialspecies: Mycoplasma pneumoniae, Chlamydophila pneumoniae, Bordetellapertussis, Streptococcus pneumoniae, or Haemophilus influenzae; or viralpathogens: influenza, adenovirus, rhinovirus, coronavirus,parainfluenza, respiratory syncytial virus, human metapneumovirus, orcoxsackievirus.

Infections of the lung are commonly caused by the following bacterialspecies: Streptococcus pneumoniae, Moraxella catarrhalis, Mycoplasmapneumoniae, Klebsiella pneumoniae, or Haemophilus influenza; or viralpathogens: influenza, adenovirus, respiratory syncytial virus, orparainfluenza.

Infections of the pleura are commonly caused by the following bacterialspecies: Staphylococcus aureus, Streptococcus pyogenes, Streptococcuspneumoniae, Haemophilus influenzae, Bacteroides fragilis, Prevotellaspp., Fusobacterium nucleatum, peptostreptococcus spp., or Mycobacteriumtuberculosis; or viral pathogens: influenza, adenovirus, respiratorysyncytial virus, or parainfluenza.

Infections of the mediastinum are commonly caused by the followingbacterial species: viridans streptococci, Peptococcus spp.,Peptostreptococcus spp., Bacteroides spp., Fusobacterium spp., orMycobacterium tuberculosis; or viral pathogens: measles, rubella,Epstein-Barr, or cytomegalovirus.

Infections of the heart are commonly caused by the following bacterialspecies: Streptococcus spp. (including S. mitior, S. bovis, S. sanguis,S. mutans, S. anginosus), Enterococcus spp., Staphylococcus spp.,Corynebacterium diptheriae, Clostridium perfringens, Neisseriameningitidis, or Salmonella spp.; or viral pathogens: enteroviruses,coxsackieviruses, echoviruses, poliovirus, adenovirus, mumps, rubeola,or influenza.

Infections of the esophagus are commonly caused by the followingbacterial species: Actinomyces spp., Mycobacterium avium, Mycobacteriumtuberculosis, or Streptococcus spp.; or viral pathogens:cytomegalovirus, herpes simplex, or varicella-zoster.

Infections of the stomach are commonly caused by the following bacterialspecies: Streptococcus pyogenes or Helicobacter pylori; or viralpathogens: cytomegalovirus, herpes simplex, Epstein-Barr, rotaviruses,noroviruses, or adenoviruses.

Infections of the small bowel are commonly caused by the followingbacterial species: Escherichia coli, Clostridium difficile, Bacteroidesfragilis, Bacteroides vulgatus, Bacteroides thetaiotaomicron,Clostridium perfringens, Salmonella enteriditis, Yersiniaenterocolitica, or Shigella flexneri; or viral pathogens: adenoviruses,astroviruses, caliciviruses, noroviruses, rotaviruses, orcytomegalovirus.

Infections of the colon/rectum are commonly caused by the followingbacterial species: Escherichia coli, Clostridium difficile, Bacteroidesfragilis, Bacteroides vulgatus, Bacteroides thetaiotaomicron,Clostridium perfringens, Salmonella enteriditis, Yersiniaenterocolitica, or Shigella flexneri; or viral pathogens: adenoviruses,astroviruses, caliciviruses, noroviruses, rotaviruses, orcytomegalovirus.

Infections of the anus are commonly caused by the following bacterialspecies: Streptococcus pyogenes, Bacteroides spp., Fusobacterium spp.,anaerobic streptococci, Clostridium spp., Escherichia coli, Enterobacterspp., Pseudomonas aeruginosa, or Treponema pallidum; or viral pathogens:herpes simplex.

Infections of the perineum are commonly caused by the followingbacterial species: Escherichia coli, Klebsiella spp., Enterococcus spp.,Bacteroides spp., Fusobacterium spp., Clostridium spp., Pseudomonasaeruginosa, anaerobic streptococci, Clostridium spp., or Enterobacterspp.; or viral pathogens: herpes simplex.

Infections of the liver are commonly caused by the following bacterialspecies: Escherichia coli, Klebsiella spp., Streptococcus (anginosusgroup), Enterococcus, spp. other viridans streptococci, or Bacteroidesspp.; or viral pathogens: hepatitis A, Epstein-Barr, herpes simplex,mumps, rubella, rubeola, varicella-zoster, coxsackieviruses, oradenovirus.

Infections of the gallbladder are commonly caused by the followingbacterial species: Escherichia coli, Klebsiella spp., Enterobacter spp.,enterococci, Bacteroides spp., Fusobacterium spp., Clostridium spp.,Salmonella enteriditis, Yersinia enterocolitica, or Shigella flexneri.

Infections of the biliary tract are commonly caused by the followingbacterial species: Escherichia coli, Klebsiella spp., Enterobacter spp.,enterococci, Bacteroides spp., Fusobacterium spp., Clostridium spp.,Salmonella enteriditis, Yersinia enterocolitica, or Shigella flexneri;or viral pathogens: hepatitis A, Epstein-Barr, herpes simplex, mumps,rubella, rubeola, varicella-zoster, cocsackieviruses, or adenovirus.

Infections of the pancreas are commonly caused by the followingbacterial species: Escherichia coli, Klebsiella spp., Enterococcus spp.,Pseudomonas spp., Staphylococcal spp., Mycoplasma spp., Salmonellatyphi, Leptospirosis spp., or Legionella spp.; or viral pathogens:mumps, coxsackievirus, hepatitis B, cytomegalovirus, herpes simplex 2,or varicella-zoster.

Infections of the spleen are commonly caused by the following bacterialspecies: Streptococcus spp., Staphylococcus spp., Salmonella spp.,Pseudomonas spp., Escherichia coli, or Enterococcus spp.; or viralpathogens: Epstein-Barr, cytomegalovirus, adenovirus, measles, rubella,coxsackieviruses, or varicella-zoster.

Infections of the adrenal gland are commonly caused by the followingbacterial species: Streptococcus spp., Staphylococcus spp., Salmonellaspp., Pseudomonas spp., Escherichia coli, or Enterococcus spp.; or viralpathogens: varicella-zoster.

Infections of the kidney are commonly caused by the following bacterialspecies: Escherichia coli, Proteus mirabilis, Proteus vulgatus,Providentia spp., Morganella spp., Enterococcus faecalis, or Pseudomonasaeruginosa; or viral pathogens: BK virus, or mumps.

Infections of the ureter are commonly caused by the following bacterialspecies: Escherichia coli, Proteus mirabilis, Proteus vulgatus,Providentia spp., Morganella spp., or Enterococcus spp.

Infections of the bladder are commonly caused by the following bacterialspecies: Escherichia coli, Proteus mirabilis, Proteus vulgatus,Providentia spp., Morganella spp., Enterococcus faecalis, orCorynebacterium jekeum; or viral pathogens: adenovirus, orcytomegalovirus.

Infections of the peritoneum are commonly caused by the followingbacterial species: Staphylococcus aureus, Streptococcus pyogenes,Streptococcus pneumonia, Escherichia coli, Klebsiella spp., Proteusspp., enterococci, Bacteroides fragilis, Prevotella melaminogenica,Peptococcus spp., Peptostreptococcus spp., Fusobacterium spp., orClostridium spp.

Infections of the retroperitoneal area are commonly caused by thefollowing bacterial species: Escherichia coli, or Staphylococcus aureus.

Infections of the prostate are commonly caused by the followingbacterial species: Escherichia coli, Klebsiella spp., Enterobacter spp.,Proteus mirabilis, enterococci spp., Pseudomonas spp., Corynebacteriumspp., or Neisseria gonorrhoeae; or viral pathogens: herpes simplex.

Infections of the testicle are commonly caused by the followingbacterial species: Escherichia coli, Klebsiella pneumoniae, Pseudomonasaeruginosa, Staphylococcus spp., Streptococcus spp., or Salmonellaenteriditis; or viral pathogens: mumps, coxsackievirus, or lymphocyticchoriomeningitis virus.

Infections of the penis are commonly caused by the following bacterialspecies: Staphylococcus aureus, Streptococcus pyogenes, Neisseriagonorrhoeae, or Treponema pallidum; or viral pathogens: herpes simplex.

Infections of the ovary/adnexae are commonly caused by the followingbacterial species: Neisseria gonorrhoeae, Chlamydia trachomatis,Gardenerella vaginalis, Prevotella spp., Bacteroides spp., Peptococcusspp. Streptococcus spp., or Escherichia coli.

Infections of the uterus are commonly caused by the following bacterialspecies: Neisseria gonorrhoeae, Chlamydia trachomatis, Gardenerellavaginalis, Prevotella spp., Bacteroides spp., Peptococcus spp.,Streptococcus spp., or Escherichia coli.

Infections of the cervix are commonly caused by the following bacterialspecies: Neisseria gonorrhoeae, Chlamydia trachomatis, or Treponemapallidum; or viral pathogens: herpes simplex.

Infections of the vagina are commonly caused by the following bacterialspecies: Gardenerella vaginalis, Prevotella spp., Bacteroides spp.,peptococci spp., Escherichia coli, Neisseria gonorrhoeae, ChlamydiaTrachomatis, or Treponema pallidum; or viral pathogens: herpes simplex.

Infections of the vulva are commonly caused by the following bacterialspecies: Staphylococcus aureus, Streptococcus pyogenes, or Treponemapallidum; or viral pathogens: herpes simplex.

Bacterial Strains/Viral Subtypes

It will be understood by a skilled person that bacterial species areclassified operationally as collections of similar strains (whichgenerally refers to groups of presumed common ancestry with identifiablephysiological but usually not morphological distinctions, and which maybe identified using serological techniques against bacterial surfaceantigens). Thus, each bacterial species (e.g., Streptococcus pneumoniae)has numerous strains (or serotypes), which may differ in their abilityto cause infection or differ in their ability to cause infection in aparticular organ/site. For example, although there are at least 90serotypes of Streptococcus pneumoniae, serotypes 1, 3, 4, 7, 8, and 12are most frequently responsible for pneumococcal disease in humans.

As a second example, certain strains of Escherichia coli, referred to asextraintestinal pathogenic E. coli (ExPEC), are more likely to causeurinary tract infection or other extraintestinal infections such asneonatal meningitis, whereas other strains, including enterotoxigenic E.coli (ETEC), enteropathogenic E. coli (EPEC), enterohemorrhagic E. coli(EHEC), Shiga toxin-producing E. coli (STEC), enteroaggregative E. coli(EAEC), enteroinvasive E. coli (EIEC) and diffuse adhering E. coli(DAEC) are more likely to cause gastrointestinal infection/diarrhea.Even among the sub-category of ExPEC strains, specific virulence factors(e.g., production of type-1 fimbriae) enable certain strains to be morecapable of causing infection of the bladder, while other virulencefactors (e.g., production of P fimbriae) enable other strains to be morecapable of causing infection in the kidneys. In accordance with thepresent invention, an ExPEC strain(s) that is more likely to causeinfection in the bladder may be chosen for a formulation to targetbladder cancer, whereas an ExPEC strain(s) that is more likely to causeinfection in the kidney may be chosen for a formulation to target kidneycancer. Likewise, one or more of an ETEC, EPEC, EHEC, STEC, EAEC, EIECor DAEC strains of E. coli (i.e., strains that cause colon infection),may be chosen for a formulation to treat colon cancer.

Similarly, there may be numerous subtypes of specific viruses. Forexample, there are three types of influenza viruses, influenza A,influenza B and influenza C, which differ in epidemiology, host rangeand clinical characteristics. For example, influenza A is more likely tobe associated with viral lung infection, whereas influenza B is morelikely to be associated with myositis (i.e., muscle infection).Furthermore, each of these three types of influenza virus have numeroussubtypes, which also may differ in epidemiology, host range and clinicalcharacteristics. In accordance with the present invention, one maychoose an influenza A subtype most commonly associated with lunginfection to target lung cancer, whereas one may choose an influenza Bstrain most commonly associated with myositis to treat cancer of themuscle/soft tissues.

It is understood that a clinical microbiologist skilled in the art wouldtherefore be able to select, based on the present disclosure and thebody of art relating to bacterial strains for each species of bacteria(and viral subtypes for each type of virus), the strains of a particularbacterial species (or subtype of a particular virus) to target aspecific organ or tissue.

Bacterial Compositions, Dosages, and Administration

The compositions of the invention include antigens of pathogenicmicrobial (bacterial or viral) species that are pathogenic in a specifictissue or organ. The compositions may include whole bacterial species,or may include extracts or preparations of the pathogenic bacterialspecies of the invention, such as cell wall or cell membrane extracts,or whole cells, or exotoxins, or whole cells and exotoxins. Thecompositions may also include one or more isolated antigens from one ormore of the pathogenic bacterial species of the invention; in someembodiments, such compositions may be useful in situations where it maybe necessary to precisely administer a specific dose of a particularantigen, or may be useful if administering a whole bacterial species orcomponents thereof (e.g., toxins) may be harmful. Pathogenic bacterialspecies may be available commercially (from, for example, ATCC(Manassas, Va., USA), or may be clinical isolates from subjects having abacterial infection of a tissue or organ (e.g., pneumonia).

The microbial compositions of the invention can be provided alone or incombination with other compounds (for example, nucleic acid molecules,small molecules, peptides, or peptide analogues), in the presence of aliposome, an adjuvant, or any pharmaceutically acceptable carrier, in aform suitable for administration to mammals, for example, humans. Asused herein “pharmaceutically acceptable carrier” or “excipient”includes any and all solvents, dispersion media, coatings, antibacterialand antifungal agents, isotonic and absorption delaying agents, and thelike that are physiologically compatible. The carrier can be suitablefor any appropriate form of administration, including subcutaneous,intradermal, intravenous, parenteral, intraperitoneal, intramuscular,sublingual, inhalational, intratumoral or oral administration.Pharmaceutically acceptable carriers include sterile aqueous solutionsor dispersions and sterile powders for the extemporaneous preparation ofsterile injectable solutions or dispersion. The use of such media andagents for pharmaceutically active substances is well known in the art.Except insofar as any conventional media or agent is incompatible withthe active compound (i.e., the specific bacteria, bacterial antigens, orcompositions thereof of the invention), use thereof in thepharmaceutical compositions of the invention is contemplated.Supplementary active compounds can also be incorporated into thecompositions.

If desired, treatment with bacterial antigens according to the inventionmay be combined with more traditional and existing therapies for cancer,such as chemotherapy, radiation therapy, surgery, etc., or with anyother therapy intended to stimulate the immune system, reduceinflammation or otherwise benefit the subject, such as nutrients,vitamins and supplements. For example, vitamin A, vitamin D, vitamin E,vitamin C, vitamin B complex, selenium, zinc, co-enzyme Q10, betacarotene, fish oil, curcumin, green tea, bromelain, resveratrol, groundflaxseed, garlic, lycopene, milk thistle, melatonin, other antioxidants,cimetidine, indomethacin, or COX-2 Inhibitors (e.g., Celebrex™[celecoxib] or Vioxx™ [rofecoxib]) may be also be administered to thesubject.

Conventional pharmaceutical practice may be employed to provide suitableformulations or compositions to administer the compounds to subjectssuffering from a cancer. Any appropriate route of administration may beemployed, for example, parenteral, intravenous, intradermal,subcutaneous, intramuscular, intracranial, intraorbital, ophthalmic,intraventricular, intracapsular, intraspinal, intrathecal,intracisternal, intraperitoneal, intranasal, inhalational, aerosol,topical, intratumoral, sublingual or oral administration. Therapeuticformulations may be in the form of liquid solutions or suspensions; fororal administration, formulations may be in the form of tablets orcapsules; for intranasal formulations, in the form of powders, nasaldrops, or aerosols; and for sublingual formulations, in the form ofdrops, aerosols or tablets.

Methods well known in the art for making formulations are found in, forexample, “Remington's Pharmaceutical Sciences” (20th edition), ed. A.Gennaro, 2000, Mack Publishing Company, Easton, Pa. Formulations forparenteral administration may, for example, contain excipients, sterilewater, or saline, polyalkylene glycols such as polyethylene glycol, oilsof vegetable origin, or hydrogenated napthalenes. Biocompatible,biodegradable lactide polymer, lactide/glycolide copolymer, orpolyoxyethylene-polyoxypropylene copolymers may be used to control therelease of the compounds. Other potentially useful parenteral deliverysystems for include ethylene-vinyl acetate copolymer particles, osmoticpumps, implantable infusion systems, and liposomes. Formulations forinhalation may contain excipients, for example, lactose, or may beaqueous solutions containing, for example, polyoxyethylene-9-laurylether, glycocholate and deoxycholate, or may be oily solutions foradministration in the form of nasal drops, or as a gel. For therapeuticor prophylactic compositions, the pathogenic bacterial species areadministered to an individual in an amount effective to stop or slowprogression or metastasis of the cancer, or to increase survival of thesubject (relative to for example prognoses derived from the SEERdatabase) depending on the disorder.

An “effective amount” of a pathogenic microbial species or antigenthereof according to the invention includes a therapeutically effectiveamount or a prophylactically effective amount. A “therapeuticallyeffective amount” refers to an amount effective, at dosages and forperiods of time necessary, to achieve the desired therapeutic result,such as reduction or elimination of the cancer cells or tumors,prevention of carcinogenic processes, slowing the growth of the tumour,or an increase in survival time beyond that which is expected using forexample the SEER database. A therapeutically effective amount of apathogenic microbial (bacterial or viral) species or antigen(s) thereofmay vary according to factors such as the disease state, age, sex, andweight of the individual, and the ability of the compound to elicit adesired response in the individual. Dosage regimens may be adjusted toprovide the optimum therapeutic response. A therapeutically effectiveamount may also be one in which any toxic or detrimental effects of thepathogenic bacterial species or virus or antigen thereof are outweighedby the therapeutically beneficial effects. A “prophylactically effectiveamount” refers to an amount effective, at dosages and for periods oftime necessary, to achieve the desired prophylactic result, such asprevention of cancer, prevention of metastasis, slowing the growth ofthe tumour, reduction or elimination of the cancer cells, tissues,organs, or tumors, or an increase in survival time beyond that which isexpected using for example the SEER database. Typically, a prophylacticdose is used in subjects prior to or at an earlier stage of cancer, sothat a prophylactically effective amount may be less than atherapeutically effective amount.

For administration by subcutaneous or intradermal injection, anexemplary range for therapeutically or prophylactically effectiveamounts of one or more pathogenic bacterial species may be about 1million to 100,000 million organisms per ml, or may be 100 million to7000 million organisms per ml, or may be 500 million to 6000 millionorganisms per ml, or may be 1000 million to 5000 million organisms perml, or may be 2000 million to 4000 million organisms per ml, or anyinteger within these ranges. The total concentration of bacteria per mlmay range from 1 million to 100,000 million organisms per ml, or may be50 million to 7000 million organisms per ml, or may be 100 million to6000 million organisms per ml, or may be 500 million to 5000 millionorganisms per ml, or may be 1000 million to 4000 million organisms perml, or any integer within these ranges. The range for therapeutically orprophylactically effective amounts of antigens of a pathogenic bacterialspecies may be any integer from 0.1 nM-0.1M, 0.1 nM-0.05M, 0.05 nM-15 μMor 0.01 nM-10 μM.

It is to be noted that dosage concentrations and ranges may vary withthe severity of the condition to be alleviated, or may vary with thesubject's immune response. In general, the goal is to achieve anadequate immune response. For administration by subcutaneous orintradermal infection, the extent of an immune response may bedetermined, for example, by size of delayed local immune skin reactionat the site of injection (e.g., from 0.25 inch to 4 inch diameter). Thedose required to achieve an appropriate immune response may varydepending on the individual (and their immune system) and the responsedesired. Standardized dosages may also be used. In the context ofsubcutaneous or intradermal administration, if the goal is to achieve a2 inch local skin reaction, the total bacterial composition dose may,for example, range from 2 million bacteria (e.g., 0.001 ml of a vaccinewith a concentration of 2,000 million organisms per ml) to more than20,000 million bacteria (e.g., 1 ml of a vaccine with a concentration of20,000 million organisms per ml). The concentrations of individualbacterial species or antigens thereof within a composition may also beconsidered. For example, if the concentration of one particularpathogenic bacterial species, cell size of that species or antigenicload thereof is much higher relative to the other pathogenic bacterialspecies in the vaccine, then the local immune skin reaction of anindividual may be likely due to its response to this specific bacterialspecies. In some embodiments, the immune system of an individual mayrespond more strongly to one bacterial species within a composition thananother, depending for example on past history of exposure to infectionby a particular species, so the dosage or composition may be adjustedaccordingly for that individual.

For any particular subject, the timing and dose of treatments may beadjusted over time (e.g., timing may be daily, every other day, weekly,monthly) according to the individual need and the professional judgementof the person administering or supervising the administration of thecompositions. For example, in the context of subcutaneous or intradermaladministration, the compositions may be administered every second day.An initial dose of approximately 0.05 ml may be administeredsubcutaneously, followed by increases from 0.01-0.02 ml every second dayuntil an adequate skin reaction is achieved at the injection site (forexample, a 1 inch to 2 inch diameter delayed reaction of visible rednessat the injection site). Once this adequate immune reaction is achieved,this dosing is continued as a maintenance dose. The maintenance dose maybe adjusted from time to time to achieve the desired visible skinreaction (inflammation) at the injection site. Dosing may be for adosage duration, for example of at least 2 weeks, 2 months, 6 months, 1,2, 3, 4, or 5 years or longer.

Oral dosages may for example range from 10 million to 1,000,000 millionorganisms per dose, comprising antigenic determinants of one or morespecies. Oral dosages may be given, for example, from 4 times per day,daily or weekly. Dosing may be for a dosage duration, for example of atleast 2 weeks, 2 months, 6 months, 1, 2, 3, 4, or 5 years or longer.

In some embodiments, the invention may include antigenic compositionsadministered sublingually or by inhalation, or administered to one ormore epithelial tissues (i.e., skin by intradermal or subcutaneousinjection; lung epithelium by inhalation; gastrointestinal mucosa byoral ingestion; mouth mucosa by sublingual administration)simultaneously or sequentially. Accordingly, in some embodiments theantigenic compositions of the invention are administered so as toprovoke an immune response in an epithelial tissue. In some embodiments,one or more epithelial routes of administration may be combined with oneor more additional routes of administration, such as intratumoral,intramuscular or intravenous administration.

In various aspects of the invention, the antigenic compositions that areadministered to a patient may be characterized as having an antigenicsignature, i.e., a combination of antigens or epitopes, that issufficiently specific that the antigenic composition is capable ofeliciting an immune response that is specific to a particular pathogen,such as an adaptive immune response. A surprising and unexpected aspectof the invention is that the non-adaptive or non-specific activation ofthe immune response that is mediated by these specific antigeniccompositions is effective to treat cancers situated in the tissues inwhich the particular pathogen is pathogenic.

Routes of administration and dosage ranges set forth herein areexemplary only and do not limit the route of administration and dosageranges that may be selected by medical practitioners. The amount ofactive compound (e.g., pathogenic bacterial species or viruses orantigens thereof) in the composition may vary according to factors suchas the disease state, age, sex, and weight of the individual. Dosageregimens may be adjusted to provide the optimum therapeutic response.For example, a single bolus may be administered, several divided dosesmay be administered over time or the dose may be proportionally reducedor increased as indicated by the exigencies of the therapeuticsituation. It may be advantageous to formulate parenteral compositionsin dosage unit form for ease of administration and uniformity of dosage.

In the case of antigenic formulations (analogous to a vaccine), animmunogenically effective amount of a compound of the invention can beprovided, alone or in combination with other compounds, with animmunological adjuvant. The compound may also be linked with a carriermolecule, such as bovine serum albumin or keyhole limpet hemocyanin toenhance immunogenicity. An antigenic composition (“vaccine”) is acomposition that includes materials that elicit a desired immuneresponse. An antigenic composition may select, activate or expand memoryB, T cells, neutrophils, monocytes or macrophages of the immune systemto, for example, reduce or eliminate the growth or proliferation ofcancerous cells or tissue. In some embodiments, the specific pathogenicmicrobe, virus, viral antigens, bacteria, bacterial antigens, orcompositions thereof of the invention are capable of eliciting thedesired immune response in the absence of any other agent, and maytherefore be considered to be an antigenic composition. In someembodiments, an antigenic composition includes a suitable carrier, suchas an adjuvant, which is an agent that acts in a non-specific manner toincrease the immune response to a specific antigen, or to a group ofantigens, enabling the reduction of the quantity of antigen in any givenvaccine dose, or the reduction of the frequency of dosage required togenerate the desired immune response. A bacterial antigenic compositionmay include live or dead bacteria capable of inducing an immune responseagainst antigenic determinants normally associated with the bacteria. Insome embodiments, an antigenic composition may include live bacteriathat are of less virulent strains (attenuated), and therefore cause aless severe infection. In some embodiments the antigenic composition mayinclude live, attenuated or dead viruses capable of inducing an immuneresponse against antigenic determinants normally associated with thevirus.

An antigenic composition comprising killed bacteria for administrationby injection may be made as follows. The bacteria may be grown insuitable media, and washed with physiological salt solution. Thebacteria may then be centrifuged, resuspended in saline solution, andkilled with heat. The suspensions may be standardized by directmicroscopic count, mixed in required amounts, and stored in appropriatecontainers, which may be tested for safety, shelf life, and sterility inan approved manner. In addition to the pathogenic bacterial speciesand/or antigens thereof, a killed bacterial vaccine suitable foradministration to humans may include 0.4% phenol preservative and/or0.9% sodium chloride. The bacterial vaccine may also include traceamounts of brain heart infusion (beef), peptones, yeast extract, agar,sheep blood, dextrose, sodium phosphate and/or other media components.

In some embodiments, the bacterial vaccine may be used in tablet orcapsule form or drops for oral ingestion, as an aerosol for inhalation,or as drops, aerosol or tablet form for sublingual administration.

In antigenic compositions comprising bacteria, the concentrations ofspecific bacterial species in compositions for subcutaneous orintradermal injection may be about 1 million to 100,000 millionorganisms per ml, or may be 100 million to 7000 million organisms perml, or may be 500 million to 6000 million organisms per ml, or may be1000 million to 5000 million organisms per ml, or may be 2000 million to4000 million organisms per ml, or any integer within these ranges. Thetotal concentration of bacteria per ml may range from 1 million to100,000 million organisms per ml, or may be 50 million to 7000 millionorganisms per ml, or may be 100 million to 6000 million organisms perml, or may be 500 million to 5000 million organisms per ml, or may be1000 million to 4000 million organisms per ml, or any integer withinthese ranges.

In some embodiments, a selected killed bacterial vaccine for cancer ofthe lung tissue would include the common bacterial lung pathogens, andmay for example be:

bacteria per ml Streptococcus pneumoniae 600 million Haemophilusinfluenzae 400 million Moraxella catarrhalis 400 million Mycoplasmapneumoniae 300 million Klebsiella pneumoniae 300 million total: 2,000millionor alternatively:

bacteria per ml Streptococcus pneumoniae 600 million Haemophilusinfluenzae 300 million Moraxella catarrhalis 300 million Mycoplasmapneumoniae 400 million Klebsiella pneumoniae 400 million total: 2,000million

In some selected embodiments, a selected killed bacterial vaccine forcancer of the lung tissue would include only more common bacterial lungpathogens, and may for example be:

bacteria per ml Streptococcus pneumoniae 800 million Haemophilusinfluenzae 600 million Moraxella catarrhalis 600 million total: 2,000millionor alternatively:

bacteria per ml Streptococcus pneumoniae 800 million Mycoplasmapneumoniae 600 million Klebsiella pneumoniae 600 million total: 2,000million

In further selected embodiments, a selected killed bacterial vaccine forcancer of the lung tissue would include only the most common bacteriallung pathogen, and may be:

bacteria per ml Streptococcus pneumoniae 2,000 million total: 2,000millionor

bacteria per ml Klebsiella pneumoniae 2,000 million total: 2,000 millionor

bacteria per ml Mycoplasma pneumoniae 2,000 million total: 2,000 million

In some embodiments, an antigenic microbial composition for treatingcancer at a particular site (e.g., cancer of the lung tissue) mayinclude pathogenic microbes that commonly, more commonly, or mostcommonly cause infection in that tissue or organ (e.g., infection in thelung tissue i.e., pneumonia).

In general, the pathogenic bacterial species and antigens thereof of theinvention should be used without causing substantial toxicity. Toxicityof the compounds of the invention can be determined using standardtechniques, for example, by testing in cell cultures or experimentalanimals and determining the therapeutic index, i.e., the ratio betweenthe LD50 (the dose lethal to 50% of the population) and the LD100 (thedose lethal to 100% of the population).

In some aspects, the invention involves the use of an anti-inflammatoryin conjunction with vaccinations. In these embodiments, a wide varietyof anti-inflammatory treatments may be employed, including effectiveamounts of non-steroidal anti-inflammatory drugs (NSAIDs), including butnot limited to: diclofenac potassium, diclofenac sodium, etodolac,indomethicin, ketorolac tromethamine, sulindac, tometin sodium,celecoxib, meloxicam, valdecoxib, floctafenine, mefenamic acid,nabumetone, meloxicam, piroxicam, tenoxicam, fenoprofen calcium,flubiprofen, ibuprofen, ketoprofen, naproxen, naproxen sodium,oxaprozin, tiaprofenic acid, acetylsalicylic acid, diflunisal, cholinemagnesium trisalicylate, choline salicylate, triethanolamine salicylate,COX1 inhibitors, COX2 inhibitors (e.g., Vioxx™, and Celebrex™). Avariety of herbs and natural health products may also be used to provideanti-inflammatory treatment, including but not limited to: green tea,fish oil, vitamin D, antioxidant vitamins and minerals (e.g., Bcarotene, vitamin A, vitamin C, vitamin D, vitamin E, co-enzyme Q10,selenium, etc.), resveratrol, turmeric, bromelain, boswellia, feverfew,quercetin, ginger, rosemary, oregano, cayenne, clove, nutmeg,willowbark. Alternative anti-inflammatory modalities may also includelifestyle modifications, such as: exercise, weight loss, smokingcessation, stress reduction, seeking social support, treatment ofdepression, stress management, abdominal breath work and dietary change(such as adopting a mediterranean diet, a low glycemic diet, eatingnon-charred foods, including foods having omega-3 fatty acids).

Example 1 Clinical Studies Bacterial Compositions

Five killed bacterial compositions have been used to treat a widevariety of cancer types and stages in blinded studies, as follows:

1. The Bayer Corporation MRV™ “Bayer MRV” (Hollister-Steir Laboratories,Spokane, Wash., U.S.A.), containing the following bacterial species:

Organisms per ml Staphylococcus aureus 1200 million viridans andnon-hemolytic Streptococci  200 million Streptococcus pneumoniae  150million Moraxella (Neisseria) catarrhalis  150 million Klebsiellapneumoniae  150 million Haemophilus influenzae  150 million

This vaccine was produced for the following indications: rhinitis,infectious asthma, chronic sinusitis, nasal polyposis and chronic serousotitis media. Cancer treatment was not indicated as an intended use forthis vaccine. The vaccine also included the following ingredients: 0.4%phenol, 0.9% NaCl, trace amounts of brain heart infusion (beef),peptones, yeast extract, agar, sheep blood, dextrose, and sodiumphosphates.

2. Stallergenes MRV “Stallergenes MRV” (Laboratories des Stallergenes,S.A., Fresnes, France), containing the following:

Organisms per ml Staphylococcus aureus 600 million Staphylococcus albus600 million non-hemolytic Streptococci 200 million Streptococcuspneumoniae 150 million Moraxella (Neisseria) catarrhalis 150 millionKlebsiella pneumoniae 150 million Haemophilus influenzae 150 million

This vaccine was produced for the same indications as the MRV vaccinei.e., recurrent respiratory tract infections, and listed cancer as acontraindication.

As set out below, surprisingly, these MRV vaccines, which contain manycommon lung pathogens, were found to be effective for the treatment oflung cancer.

3. Polyvaccinum Forte (PVF; Biomed S.A., Krakow, Poland), containing thefollowing:

Organisms per ml Staphylococcus aureus 500 million Staphylococcusepidermidis 500 million Escherichia coli 200 million Corynebacteriumpseudodiphtheriticum 200 million Streptococcus pyogenes 100 millionStreptococcus salivarius (viridans Streptococci) 100 millionStreptococcus pneumoniae 100 million Moraxella (Neisseria) catarrhalis100 million Klebsiella pneumoniae 100 million Haemophilus influenzae 100million

This vaccine was produced for chronic and recurrent inflammatoryconditions of the upper and lower respiratory tract and genitourinarytract, including rhinopharyngitis, recurrent laryngitis, tracheitis,bronchitis, otitis media, chronic and recurrent neuralgia of trigeminaland occipital nerve, ischialgia, brachial plexitis, intercostalsneuralgia, chronic cystoureteritis, vaginitis, adnexitis, andendometrium inflammation. Cancer treatment was not indicated as anintended use for this vaccine.

Of note, although the total concentration of bacteria in PVF isidentical to that of the MRVs (Bayer and Stallergenes), patientstypically demonstrated a visible inflammatory immune response tosubcutaneous injection of the PVF composition at a much smaller dosethan the usual dose required to achieve a similar skin response with theMRV composition, indicating that the immune reaction was likelyoccurring to one of the novel components in the Polyvaccinum Fortevaccine, such as E. coli. As set out below, surprisingly, PVF, whichcontains E. coli a common pathogen of the colon, abdomen, kidney,ovaries, peritoneum, liver and pancreas, has been found to be effectivein the treatment of cancers in the colon, abdominal lymph nodes, kidney,ovary, peritoneum, liver and pancreas.

4. Staphage Lysate (Delmont Laboratories Inc., Swarthmore, Pa., USA),containing the following:Staphylococcus aureus

As set out below, surprisingly, Staphage Lysate, which containsStaphylococcus aureus a common pathogen of the breast and bone, wasfound to be effective in the treatment of cancer in the breast and bone.

Administration of MRV, Staphage Lysate and PVF

The bacterial compositions (vaccines) were a suspension of killedbacterial cells and therefore, the suspensions were gently shaken priorto use to ensure uniform distribution prior to withdrawing dose fromvial, and administered subcutaneously three times a week on Mondays,Wednesdays, and Fridays. Patients were advised to continue treatment forat least 6 months. The dose of vaccine required was determined by theadequacy of the immune reaction to the vaccine. Beginning with a verysmall dose (0.05 cc), the dose was gradually increased (by 0.01-0.02 cceach time) until an adequate immune reaction was achieved. This delayedlocal reaction at the injection site appeared within 2-48 hours afterinjection and lasted for up to 72 hours or longer. The goal was toachieve a one to two inch diameter round patch of pinkness/redness atthe injection site, indicating adequate immune stimulation. Once thisreaction was achieved, the dose was maintained at the level required toachieve this reaction. If the reaction was significantly less than twoinches (e.g., half an inch) the dose was increased, if it wassignificantly more than two inches (e.g., three inches), the dose wasdecreased. This local immune reaction generally occurs within the first24 hours after the injection. Patients were asked to check for thisreaction and, if present, to measure or mark it. The maintenance doserequired to achieve an adequate immune reaction varies considerably,depending on the individual's immune response—as little as 0.001 cc forsome people, as much as 2 cc for others. The vaccine must be stored in arefrigerator (2° to 8° C.). The usual site for injection is the upperarms, the thighs or the abdomen. The exact site of each injection wasvaried so that it was not given in sites in which pinkness/redness wasstill present. A known contraindication to the vaccines ishypersensitivity to any component of the vaccine.

A fifth vaccine, a polymicrobial oral vaccine, was used in alternativeaspects of the invention, as follows:

5. Respivax, produced by BB-NCIPD Ltd (Bulgaria). This oral vaccinecontained the following freeze-dried killed bacterial species:

Organisms per mg Streptococcus pneumoniae 25 million Neisseriacatarrhalis 25 million Streptococcus pyogenes 25 million Haemophilusinfluenzae 25 million Staphylococcus aureus 25 million Klebsiellapneumoniae 25 million

Administration of Respivax

The Respivax oral vaccine was produced for the treatment for chronicrespiratory infection, and contains many of the most common respiratorytract pathogens, including many of the most common causes of lunginfection. Patients were treated with a dose of one 50 mg tablet perday, providing the equivalent of 1.25×10⁹ cells of each species perdose. Patients were prescribed the above dose for a continuous period ofat least 6 months.

As set out below, surprisingly, Respivax oral vaccine, which containsmany common lung pathogens, was found to be effective for the treatmentof cancer of the lung.

Example 1A Cancer of the Lung

This section relates to primary cancer in the lung, or metastases to thelung, treated with microbial pathogens of the lung, such as endogenousrespiratory bacteria flora.

Patients qualified for the lung cancer study if they were initiallydiagnosed with stage 3B or 4-lung (inoperable) cancer. Lung cancerstaging was performed using standard methods as for example described inAJCC: Cancer Staging Handbook (sixth edition) 2002; Springer-Verlag NewYork: Editors: Fredrick Greene, David Page and Irvin Fleming, or inInternational Union Against Cancer: TNM Classification of MalignantTumors (sixth edition) 2002; Wiley-Liss Geneva Switzerland: Editors: L.H. Sobin and C. H. Wittekind. For example, lung cancers may beclassified as follows:

TNM Lung Clinical and Pathological Classification

-   T PRIMARY TUMOUR-   TX Primary tumour cannot be assessed, or tumour proven by the    presence of malignant cells in sputum or bronchial washings but not    visualized by imaging or bronchoscopy-   Tis Carcinoma in situ-   T0 No evidence of primary tumour-   T1 Tumour 3 cm or less in greatest dimension, surrounded by lung or    visceral pleura, without bronchoscopic evidence of invasion more    proximal than the lobar bronchus (ie, not in the main bronchus)-   T2 Tumour with any of the following features of size or extent: More    than 3 cm in greatest dimension Involves main bronchus, 2 cm or more    distal to the carina Invades visceral pleura Associated with    atelectasis or obstructive pneumonitis that extends to the hilar    region but does not involve the entire lung-   T3 Tumour of any size that directly invades any of the following:    chest wall (including superior sulcus tumours), diaphragm,    mediastinal pleura, parietal pericardium; or tumour in the main    bronchus less than 2 cm distal to the carina but without involvement    of the carina; or associated atelectasis or obstructive pneumonitis    of the entire lung-   T4 Tumour of any size that invades any of the following:    mediastinum, heart, great vessels, trachea, esophagus, vertebral    body, carina; or tumour with a malignant pleural or pericardial    effusion; or with separate tumour nodule(s) within the ipsilateral    primary-tumour lobe of the lung,-   N REGIONAL LYMPH NODES-   NX Regional lymph nodes cannot be assessed-   N0 No regional lymph node metastasis-   N1 Metastasis in ipsilateral peribronchial and/or ipsilateral hilar    lymph nodes and intrapulmonary nodes, including involvement by    direct extension-   N2 Metastasis in ipsilateral mediastinal and/or subcarinal lymph    node(s)-   N3 Metastasis in contralateral mediastinal, contralateral hilar,    ipsilateral or contralateral scalene, or supraclavicular lymph    node(s)-   M DISTANT METASTASIS-   MX Distant metastasis cannot be assessed-   M0 No distant metastasis-   M1 Distant metastasis; includes separate tumour nodule(s) in the    non-primary-tumour lobe (ipsilateral or contralateral)

Stage Grouping of TNM Subsets:

  Occult TX N0 M0 carcinoma Stage 0 Tis N0 M0 Stage IA T1 N0 M0 Stage IBT2 N0 M0 Stage IIA T1 N1 M0 Stage IIB T2 N1 M0 T3 N0 M0 Stage IIIA T3 N1M0 T1 N2 M0 T2 N2 M0 T3 N2 M0 Stage IIIB Any T N3 M0 T4 Any N M0 StageIV Any T Any N M1

Charts with diagnostic codes 162.9 (lung cancer) and 197 (metastaticcancer) were collected manually and electronically. Information wascollected on these patients, such as date of diagnosis, date of death,and cancer stage. Charts for patients were reviewed to confirm the dateof diagnosis and cancer stage. Patients were excluded from the analysisfor the following reasons: 1) wrong stage; 2) missing data; 3) no chart,or; 4) chart did not reach in time for the data analysis. 20 patientswere excluded from the study because their charts have not arrived yetor there was insufficient information, of which 6 were MRV users. Thestudy group includes 108 patients in total: 50 who took the MRV vaccineand 58 who did not take the MRV vaccine.

Comparison of survival of patients initially diagnosed with stage 3B and4 lung cancer who took MRV with patients who didn't take MRV and withSEER standard survival data for patients initially diagnosed with stage3B and 4 lung cancer (FIG. 1) was as follows:

SEER non-MRV MRV median survival: 5 months 10.5 months 12.5 monthssurvival at 1 year: 25% 45% 58% survival at 3 years:  5%  3% 20%survival at 5 years:  3%  0% 10%

A comparison of survival (as above), including only those patients whotook MRV for at least 2 months (FIG. 2) is as follows:

median survival: 16.5 monthssurvival at 1 year: 70%survival at 3 years: 27%survival at 5 years: 15%

Median survival and survival at 1 year, 3 years and 5 years, wassubstantially better in the group that was treated with MRV (containingbacteria which commonly cause lung infection), evidence of theeffectiveness of this vaccine for the treatment of lung cancer. Patientswho were treated with the MRV vaccine for more than 2 months had highersurvival rates, further evidence of the effectiveness of this vaccinefor the treatment of lung cancer.

An alternative analysis was conducted on data that included a patientpopulation to whom the MRV composition was not available, to address aperceived potential for bias caused by sicker patients being more likelyto choose the novel treatment (with MRV) and healthier patients beingpotentially less likely to submit to the use of the antigeniccompositions of the invention. Comparison of survival of MRV patients towhom the MRV composition was available (designated “Lung 1”) to survivalof non-MRV patients to whom the MRV composition was not available(designated “Lung 2”) removes some of this selection bias, providing aclearer and more accurate illustration of the benefit of MRV treatment,as illustrated in FIG. 3.

In some embodiments, particularly striking clinical benefits have beenobtained with antigenic bacterial compositions used in repeated frequentinjections (i.e., three times per week) for a prolonged period oftime—such as at least 2, 3, 4, 5, 6 or 12 months, or 2, 3, 4 or 5 years(in the context of advanced cancer such as inoperable lung cancer, thelonger periods may be most beneficial). Treatments of this kind may becarried out so as to provide sustained, prolonged immune stimulation.When the above analysis is restricted to patients who were treated withMRV for a minimum of 2 months, the survival advantage of MRV treatmentis even more clearly illustrated FIG. 4.

As illustrated in FIG. 4, one-year survival of stage 3B or 4 lung cancerpatients treated with MRV for at least two months was 70%, compared tojust 48% for the non-MRV Lung 2 group and 23% for the SEER databasegroup. 3-year survival of the MRV group was more than 4 times that ofboth the non-MRV patients and the SEER registry. None of the non-MRVgroup in the Lung 2 study survived for 5 years, whereas 15% of patientstreated with MRV for a minimum two-month period were still alive 5 yearsafter diagnosis. In the context of an illness such as inoperable lungcancer that is considered terminal and has a usual 5-year survival rateof only 3% (SEER registry), the above results are extremely encouragingand surprising.

When the analysis of patient data is restricted to patients who weretreated with MRV for at least 6 months, the survival curve is trulyremarkable, as illustrated in FIG. 5. More than 60% of patients werealive at 3 years, more than 10 times the survival in both the non-MRVgroup and the SEER registry. 36% (5 of 14 patients) of patients who weretreated with MRV for at least 6 months were alive 5 years afterdiagnosis, compared with only 3% in the SEER database and 0% in thenon-MRV group. These remarkable results, in the context of a cancerdiagnosis that is considered terminal, are extremely promising andsurprising. Accordingly, in some embodiments, cancers, such as advancedcancers, such as inoperable lung cancer, may be treated over a dosingduration of at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 or 12 months, 2years, 3 years, 4 years, 5 years, or indefinitely.

Restricting analysis to those patients who were treated with MRV for aminimum period of time (e.g., 6 months) introduces a bias in favour ofthe MRV group, since MRV patients who survived for less than that periodof time are excluded from the group (including those who died beforethey could complete the 6 months of treatment). A detailed statisticalanalysis of this bias, with compensatory exclusion of short-termsurvivors in both the non-MRV and SEER groups, demonstrates that thisbias played a very minor role in the truly remarkable survival advantageof patients who were treated with the MRV for at least 6 months.

In stage 3B lung cancer, cancer is confined to the lungs, and thus, atargeted anti-cancer treatment response may be stimulated, in accordancewith various aspects of the invention, by a vaccine, such as MRV,comprised of lung pathogens. In stage 4 lung cancer, the cancer hasmetastasized to distant organs not amenable to targeted stimulation bylung pathogens in accordance with methods of the invention. Thus, inaccordance with some embodiments, patients with stage 3B lung cancer maybe selected for treatment with MRV vaccine, since all of the cancer isconfined to the lungs and thus, will be targeted by the MRV vaccine.When the analysis of patient data is restricted to patients with stage3B lung cancer, comparison of survival curves even more clearlyillustrates the benefit of MRV treatment. As illustrated in FIG. 11,one-year survival of stage 3B lung cancer patients treated with MRV was76%, compared to just 53% for the non-MRV Lung 2 group and 23% for theSEER database group. 3-year survival of the MRV group was 3 times thatthe non-MRV patients and more than 6 times the SEER registry. None ofthe non-MRV group survived for 5 years, whereas 14% of stage 3B patientstreated with MRV were still alive 5 years after diagnosis. In thecontext of an illness such as inoperable stage 3B lung cancer that isconsidered terminal and has a usual 5-year survival rate of only 5%(SEER registry), the above results are extremely encouraging andsurprising.

As some patients did not have their first visit for many months or evena year or two after diagnosis, their inclusion in the survival curvesskews the curve towards longer survival. In order to determine whetherthis bias influenced the difference in survival curves, survival wasanalysed from date of first visit which excludes this bias, asillustrated in FIG. 12. Comparison of survival curves of stage 3B lungcancer patients in FIG. 12 demonstrates an even greater survival benefitfor MRV treatment than illustrated in FIG. 11, indicating that thebenefit of MRV treatment was partially masked in FIG. 11. As illustratedin FIG. 12, 1-year survival (from date of first visit) of stage 3B lungcancer patients treated with MRV was 57%, compared to only 21% for stage3B patients not treated with MRV. While no stage 3B lung cancer patientsnot treated with MRV survived for 3 years, 3-year survival of stage 3Bpatients treated with MRV was 33% and 5-year survival was 14%, aremarkable and unexpected result.

When analysis was restricted to stage 3B lung cancer patients whosefirst visit was within 3 months of diagnosis, the benefits of earlytreatment with MRV are clearly illustrated. As illustrated in FIG. 13,while all stage 3B lung cancer patients who had their first visit within3 months of diagnosis died within 1 year of diagnosis, 70% of stage 3Blung cancer patients treated with MRV within 3 months of diagnosissurvived for 1 year, 40% survived 3 years and 20% survived years, atruly remarkable survival benefit for early MRV treatment.

One aspect of the invention involves the treatment of primary lungcancers or metastasis to the lung with antigenic compositions thatcomprise antigenic determinants of microbial pathogens that are known tobe lung pathogens, such as exogenous lung pathogens or pathogens thatare members of the endogenous flora of the respiratory system. Forexample, antigenic determinants of the endogenous bacterial respiratoryflora species that most commonly cause infection in the lung (see Table5) may be used to treat primary and metastatic cancers situated in thelung: Streptococcus pneumoniae, Moraxella catarrhalis, Mycoplasmapneumoniae, Klebsiella pneumoniae, Haemophilus influenza. Similarly,common viral lung pathogens from Table 5 may be selected for use in someembodiments. Alternatively, a more exhaustive list of endogenous lungpathogens may be selected from Table 1, based on the pathogenicityinformation provided in Table 2. In further alternative embodiments,viral lung pathogens listed in Table 4 may be used. And in furtheralternative embodiments, exogenous bacterial lung pathogens from Table 3may be used in formulating antigenic compositions of the invention, i.e.selected from the group consisting of: Achromobacter spp., Actinomaduraspp., Alcaligenes spp., Anaplasma spp., Bacillus anthracis, otherBacillus spp., Balneatrix spp., Bartonella henselae, Bergeyellazoohelcum, Bordetella holmesii, Bordetella parapertussis, Bordetellapertussis, Borrelia burgdorferi, Borrelia recurrentis, Brucella spp.,Burkholderia gladioli, Burkholderia mallei, Burkholderia pseudomallei,Campylobacter fetus, Capnoctyophaga canimorsus, Capnoctyophagacynodegmi, Chlamydia pneumoniae, Chlamydia psittaci, Chlamydophilapneumoniae, Chromobacterium violaceum, Chlamydophila psittaci,Chryseobacterium spp., Corynebacterium pseudotuberculosis, Coxiellaburnetii, Francisella tularensis, Gordonia spp., Legionella spp.,Leptospirosis spp., Mycobacterium avium, Mycobacterium kansasii,Mycobacterium tuberculosis, other Mycobacterium spp., Nocardia spp.,Orientia tsutsugamushi, Pandoraea spp., Pseudomonas aeruginosa, otherPseudomonas spp., Rhodococcus spp., Rickettsia conorii, Rickettsiaprowazekii, Rickettsia rickettsiae, Rickettsia typhi.

For example, since the MRV compositions contain many of the most commonlung pathogens, these vaccines may be used to treat primary lung canceror lung metastases, as illustrated in the cumulative data presentedhere, and in a number of the case reports. In accordance with theforegoing results, one aspect of the invention involves the treatment ofprimary lung cancer and metastasis to the lung with antigeniccompositions that comprise antigenic determinants of microbial pathogensthat are known to be pathogenic in the lung, such as exogenous lungpathogens or pathogens that are members of the endogenous flora of therespiratory tract. In selected embodiments, antigenic determinants ofthe common lung pathogens may be used to treat primary and metastaticcancers situated in the lung, for example, antigenic determinants fromone or more of the following bacterial species or viral types:Streptococcus pneumoniae, Moraxella catarrhalis, Mycoplasma pneumoniae,Klebsiella pneumoniae, Haemophilus influenza, influenza virus,adenovirus, respiratory syncytial virus, parainfluenza. In furtherselected embodiments, antigenic determinants of Streptococcuspneumoniae, the most common cause of bacterial lung infection, may beused alone or with other of the most common pathogens of the lung totreat cancer of the lung.

Primary lung cancer may also arise from bronchial tissue and therefore,in some embodiments, antigenic compositions that comprise antigenicdeterminants of microbial pathogens that are known to cause bronchialinfection may be used to treat patients with cancer situated in thebronchial tissue, including, for example, the following common causes ofbronchial infection: Mycoplasma pneumoniae, Chlamydophila pneumoniae,Bordetella pertussis, Streptococcus pneumoniae, Haemophilus influenzae,influenza virus, adenovirus, rhinovirus, coronavirus, parainfluenza,respiratory syncytial virus, human metapneumovirus, or coxsackievirus.Lung cancer (or lung metastases) that is located in both lung andbronchial tissue may be treated with antigenic compositions thatcomprise antigenic determinants of microbial pathogens that are known tocause both lung and bronchial infection (for example, Streptococcuspneumoniae, Haemophilus influenza and Mycoplasma pneumoniae are allcommon lung and bronchial pathogens) or alternatively, with antigeniccompositions that comprise antigenic determinants of microbial pathogensthat are known to cause lung infection and antigenic determinants ofmicrobial pathogens that are known to cause bronchial infection.

Example 1B Breast Cancer with Metastasis to the Bone or Lung

The most common cause of both breast infection and bone infection isStaphylococcus aureus. Accordingly, in one aspect of the invention, anantigenic composition comprising antigenic determinants of S. aureus maybe used to treat breast cancer with metastases to the bone. Theremarkable case of Patient R (PtR), treated with a Staphylococcus aureusvaccine, set out below in the Case Reports, illustrates the efficacy ofthis approach to treating breast cancer with bone metastases. Asillustrated in FIG. 6, in a cumulative series of 52 patients, survivalof breast cancer patients with metastases to bone and/or lung treatedwith MRV (n=19), which contains Staphylococcus aureus, was better thanthe survival of patients not treated with the MRV vaccine (n=33):

% survival MRV patients % survival non-MRV patients 10 months 95% 76% 20months 74% 61%  5 years 26% 18%

In accordance with the foregoing results, one aspect of the inventioninvolves the treatment of primary cancer in the breast or metastasis tothe breast with antigenic compositions that comprise antigenicdeterminants of microbes that are known to cause breast infection, andtreatment of primary cancer of the bone or metastasis to the bone withantigenic compositions that comprise antigenic determinants of bacterialspecies or viruses that are known to cause bone infection. In selectedembodiments, a vaccine comprising antigenic determinants ofStaphylococcus aureus, the most common cause of both breast and boneinfection, may be used alone or in combination with other of the mostcommon pathogens of the breast to treat cancer in the breast, or aloneor in combination with other of the most common pathogens of the bone totreat cancer in the bone.

Example 1C Metastases to the Bone

One of the most common sites for metastases in patients with prostatecancer is bone. In one aspect of the invention, the MRV composition,which contains antigenic determinants of S. aureus, the most commoncause of bone infection, may be used for the treatment of metastases tothe bone, for example in patients who have, or who have had, a primaryprostate cancer. The graph of FIG. 7 is a comparison of survival of acumulative series of metastatic prostate cancer patients who had surgeryor radiation to destroy their prostate gland (and thus, the primarytumour) and who had detectable cancer limited to bone metastases. Asillustrated, the survival of patients treated with MRV (n=4) issubstantially better than that of patients not treated with MRV (n=7):

% survival MRV patients % survival non-MRV patients 2 years 100%  57% 3years 75% 43% 5 years 50%  0%

In accordance with the foregoing results, one aspect of the inventioninvolves the treatment of primary bone cancers or metastases to the bonewith antigenic compositions that comprise antigenic determinants ofmicrobial pathogens that are known to cause bone infection, such asexogenous bone pathogens or pathogens that are members of the endogenousflora of the skin, mouth or colon. For example, in selected embodiments,antigenic determinants of one or more of the following microbial speciesfrom the list of common bone pathogens may be used to treat primary andmetastatic cancers situated in the bone: Staphylococcus aureus,coagulase-negative staphylococci, Streptococcus pyogenes, Streptococcuspneumoniae, Streptococcus agalactiae, other streptococci spp.,Escherichia coli, Pseudomonas spp., Enterobacter spp., Proteus spp.,Serratia spp., parvovirus B19, rubella, hepatitis B. In further selectedembodiments, Staphylococcus aureus, the most common cause of boneinfection, may be used alone or with other of the most common pathogensof the bone to treat cancer of the bone.

Example 1D Cancer Situated in the Colon

Treatment with the PVF composition has been shown to improve thesurvival of colon cancer patients (see FIG. 8), as illustrated by acomparison of the following four colon cancer patient groups:

-   -   Stage 4 colon cancer patients who were treated with MRV.    -   Stage 4 colon cancer patients who were not treated with a        vaccine.    -   Stage 4 colon cancer patients who were treated with PVF vaccine.    -   Stage 4 colon cancer patients from the SEER (Surveillance,        Epidemiology and End Results) database.

This example illustrates that patients with colon cancer treated withPVF, which contains E. coli the most common cause of bacterial infectionof the colon, have substantially improved survival.

Patients qualified for the first two groups of this study if theypresented with stage 4 colon cancer. Patients were excluded from thisanalysis for the following reasons:

-   -   incorrect diagnosis    -   incorrect stage    -   missing essential data (e.g., date of death)    -   no chart    -   chart did not reach us in time for the data analysis.

The patient group included a total of 136 stage 4 colon cancer patients:15 who took the PVF vaccine, 56 who took the MRV vaccine, and 65 who didnot take a vaccine. Results are illustrated in FIG. 8, as follows:

SEER no vaccine MRV PVF median survival: 8.4 mo. 15.1 mo. 15.0 mo. 33.6mo. at 10 months 45% 69% 71% 100%  at 20 months 24% 42% 36% 67% at 30months 14% 29% 23% 52% at 5 years  5%  6%  7% 10%

The median survival of patients with stage 4 colon cancer treated withPVF (which contains E. coli, one of the most common colonic pathogens)was more than double that of patients treated with MRV (which does notcontain colonic pathogens) or patients not treated with a vaccine, andfour times that of the SEER registry. All 15 patients treated with PVFwere still alive 10 months after diagnosis, compared to only 71% for theMRV group, 69% for the no-vaccine group and only 45% for the SEERregistry. Survival at 30 months for the PVF group was double that ofboth the MRV group and the no-vaccine group and almost 4 times that ofthe SEER registry.

The wilcoxon test shows a statistically significant survival differencebetween patients treated with PVF vaccine and both the MRV group(p=0.0246) and the no vaccine group (p=0.0433). This is remarkableconsidering the small size of the PVF group (n=15), indicative ofsubstantial therapeutic effect. As evidenced by these results, the PVFcomposition, which contains E. coli the most common cause of bacterialinfection of the colon, is an effective treatment for colon cancer.

Survival of those patients who presented for immunological treatment inaccordance with the invention within 3 months of diagnosis (i.e.,excluding those patients who were long-term survivors before presentingfor treatment) has also been analyzed. The results of this analysis arepresented in FIG. 9. As illustrated, the ‘MRV’ and ‘No Vaccine’ survivalcurves in FIG. 9 are shifted substantially to the left (indicating thata selection bias towards ‘long-term’ survivors may have artifactuallyshifted these curves to the right in FIG. 8), whereas, remarkably, thePVF curve in FIG. 9 is actually further to the right than the curve inFIG. 8, indicating that the benefit of earlier treatment with PVF (i.e.,within 3 months of diagnosis) more than outweighed any long-termsurvivor bias excluded in FIG. 9. This analysis provides compellingevidence that the benefit of PVF treatment for stage 4 colon cancer maybe even greater than that illustrated in FIG. 8, and that the earlierthe treatment with the compositions of the invention is begun followingdiagnosis, the greater the benefit.

In accordance with the foregoing results, one aspect of the inventioninvolves the treatment of colon cancers with antigenic compositions thatcomprise antigenic determinants of microbial pathogens that are known tobe colon pathogens, such as pathogens that are members of the endogenousflora of the colon or exogenous colonic pathogens. For example,antigenic determinants of the following microbial species may be used totreat primary and metastatic cancers situated in the colon: Escherichiacoli, Clostridium difficile, Bacteroides fragilis, Bacteroides vulgatus,Bacteroides thetaiotaomicron, Clostridium perfringens, Salmonellaenteriditis, Yersinia enterocolitica, Shigella flexneri; adenoviruses,astroviruses, caliciviruses, noroviruses, rotaviruses, orcytomegalovirus. For example, cancers situated in the colon may betreated with the PVF composition, which contains E. coli, or alternativeformulations that include only antigenic determinants of colonicpathogens. In selected embodiments, antigenic determinants of E. coli,the most common bacterial cause of colon infection, may be used alone orwith antigenic determinants of other common pathogens of the colon totreat cancer of the colon.

Example 1E Use of Respivax, an Oral Vaccine to Treat Lung Cancer

Oral Respivax vaccine was administered as described above, with a doseof one 50 mg tablet per day, providing the equivalent of 1.25×10⁹ cellsof each species per dose. Patients were advised to continue the abovedose for at least 6 months.

As illustrated in FIG. 10, survival of stage 3B lung cancer patients whowere treated with the oral Respivax antigens was substantially betterthan patients who were not treated with the antigenic composition.Median survival was 37 months for the patients treated with Respivax,compared to only 20 months for those patients not treated with anantigenic composition vaccine. 40% of patients treated with Respivaxwere alive 5 years after diagnosis, whereas none of the untreatedpatients survived for more than 2 years.

In accordance with the foregoing results, one aspect of the inventioninvolves the treatment of primary of the lung or metastases to the lungwith oral administration of antigenic compositions that compriseantigenic determinants of microbial pathogens that commonly cause lunginfection.

Example 2 Case Reports

These case reports are indicative of the patients that make up thepatient populations reflected in the foregoing cumulative studies, aswell as illustrating additional aspects of the invention. In particular,the individual case reports of Patients A-N are illustrative ofsurprising results in some patients being treated withanti-inflammatories, while the case reports of Patients O-AA arerepresentative of the general patient population that includes manyexamples of vaccine treatment that was effective in the absence ofanti-inflammatory therapy.

MRV for Cancer of the Lund with and without Anti-Inflammatories

Patient A (PtA): In September year 0, PtA developed right upper chestpain with an associated wheeze. These symptoms persisted and in January,year 1, she had a chest x-ray that revealed a large 7 cm×8 cm mass inthe apex of the right lung. A fine needle aspiration was positive fornon-small cell lung cancer. On January 27, year 1, an MRI showedinvasion of the subclavian arteries, making surgical resectionimpossible and thus, PtA was diagnosed with stage 3B inoperable terminallung cancer. She underwent a short course of palliative radiation anddeclined chemotherapy. She was told that she had terminal cancer with a3 to 6 months life expectancy.

On April 29, year 1, PtA began therapy with MRV vaccine three times perweek. On that same date she also began treatment with the non-steroidalanti-inflammatory agent (NSAID) indomethicin 50 mg four times per dayand a regime of antioxidant supplements and vitamin D. 18 months later,by October, year 2, the tumour had markedly reduced in size to 3 cm indiameter and, by May 19, year 5, four years after starting treatmentwith the combined regime of MRV vaccine, indomethicin, antioxidantsvitamins and vitamin D, only residual scarring remained. PtA continuedtreatment with this combination of MRV vaccine and adjuvantanti-inflammatory therapies for more than 4 years until the end of May,year 5 at which time there was no evidence of residual cancer, in spiteof a diagnosis of terminal inoperable lung cancer more than 4 yearspreviously. More than 14 years since diagnosis with terminal lungcancer, PtA continues to feel well with no evidence of residual cancer.

In accordance with the foregoing results, one aspect of the inventioninvolves the treatment of cancers in the lung with administration ofantigenic compositions that comprise antigenic determinants of microbialpathogens that commonly cause lung infection.

In accordance with the forgoing results, another aspect of the inventioninvolves the administration of the immunogenic compositions repeatedlyrelatively frequently over a relatively long period of time.

The concomitant use of anti-inflammatory agents, such as antioxidants,vitamin D and indomethicin, in conjunction with targeted MRV therapy,was associated with substantially improved survival, which was greaterthan that of otherwise similar cases, in which these adjuvantanti-inflammatory modalities were not used in conjunction with thecompositions of the invention. For example, Patient B, an otherwisesimilar case in which anti-inflammatories were not administered, wasdiagnosed with inoperable stage 3B non-small cell lung cancer, which wasfatal within 3 months of diagnosis. These cases provide evidence of asynergistic effect between the antigenic compositions of the inventionand anti-inflammatory treatments.

In accordance with the foregoing results, one aspect of the inventioninvolves the treatment of cancers with both the administration ofantigenic compositions that comprise antigenic determinants of microbialpathogens that are pathogenic to the organ or tissue targeted, as wellas adjuvant anti-inflammatory treatments, for synergistic effect.

MRV for Cancer of the Lung with and without Anti-Inflammatories

Patient C (PtC): In the spring of year 0, PtC began having pain in hisright upper chest area. This pain persisted and on October 5, year 0 hehad a chest x-ray that revealed a large 12 cm×11 cm mass occupyingvirtually the entire right upper lobe. A fine needle aspiration waspositive for poorly differentiated non-small cell lung cancer.Exploratory thoracotomy was performed on December 7, year 0, whichrevealed tumour invasion of the chest wall and superior vena cava andtherefore, PtC's tumour was inoperable (i.e., stage 3B).

PtC underwent a short course of palliative radiation and declinedchemotherapy. He was told that he had terminal cancer with a 3 to 6months life expectancy. By January 27, year 1, the rapidly growingtumour had increased in size to 14 cm×11.5 cm.

On February 9, year 1, PtC began treatment with indomethicin 50 mg fourtimes per day, antioxidant vitamins, and vitamin D. Three weeks later,on March 1, year 1, PtC began treatment with MRV vaccine three times perweek. By June, year 1, PtC was feeling well and was running 8 km 3-4times per week. On June 4, year 1, a chest x-ray revealed that thetumour had reduced in size to 11 cm diameter. PtC continued to feel verywell, leading a full and active life with return to full employment andcontinued full physical activity. PtC continued treatment with acombination of the MRV vaccine and adjuvant anti-inflammatory therapies(indomethicin, antioxidants and vitamin D) for more than 16 months untilJuly 24, year 2, at which time indomethicin treatment was discontinued(as a result of decreased kidney function, a known potential side-effectof long-term indomethicin use). 6 months later, in December, year 2,after 22 months of targeted vaccine therapy, MRV treatment wasdiscontinued (since MRV was no longer available past that date). PtCcontinued to feel well until June, year 6, at which time he wasdiagnosed with a recurrence of cancer in both lungs, which lead to hisdeath on May 26, year 7, more than 6.5 years after he was diagnosed withterminal lung cancer and told he had 3-6 months to live.

In this case, the use of adjuvant anti-inflammatory agents, includingantioxidants, vitamin D and indomethicin, used in conjunction withtargeted MRV therapy for more than 16 months, was associated withsubstantially improved survival in the face of a diagnosis that isusually fatal within 1 year, which was greater than that of an otherwisesimilar case, Patient D, in which these adjuvant anti-inflammatorymodalities were not used in conjunction with the compositions of theinvention, and an inoperable lung cancer was fatal within 8 months ofdiagnosis. These cases provide evidence of a synergistic effect betweenthe antigenic compositions of the invention and anti-inflammatorytreatments.

PVF for Cancer of the Colon with Metastases to the Liver and Lung, andwithout Anti-Inflammatories

Patient E (PtE): PtE had a surgical resection of colon cancer on June17, year 0, followed by chemotherapy. On August 15, year 0, he wasdiagnosed stage 4 cancer with metastases to the liver and lungs, adiagnosis with a very poor prognosis. On October 20, year 0, PtE begantreatment with an antioxidant and vitamin D regime and, on December 10,year 0, he began treatment with the PVF composition three times perweek, which he has continued in combination with the antioxidants andvitamin D. In September, year 1, he began treatment with Celebrex™ 100mg twice per day. In spite of a very poor initial prognosis, PtE wasstill and feeling well at last contact, more than 3 years afterdiagnosis with terminal metastatic colon cancer.

In accordance with the foregoing results, one aspect of the inventioninvolves the treatment of cancers of the colon, liver and lung withadministration of antigenic compositions that comprise antigenicdeterminants of microbial pathogens that are known to be pathogenic inthe colon, liver and lung.

In contrast to PtE, of the 15 patients diagnosed with stage 4 coloncancer and treated with PVF, the patient with the shortest survival,Patient F, was not treated with anti-inflammatories. These cases providecompelling evidence that anti-inflammatory modalities (i.e., Celebrex™,anti-oxidants and vitamin D) taken in conjunction with targeted PVFtherapy has a synergistic effect, contributing to PtE's prolongedsurvival, which was greater than that of otherwise similar cases inwhich these adjuvant anti-inflammatory modalities were not used inconjunction with the compositions of the invention.

PVF for Cancer of the Colon with Metastases to Lung, withAnti-Inflammatories

Patient G (PtG): PtG developed rectal bleeding in May, year 0, and wasdiagnosed with colon cancer. He underwent surgery, chemotherapy andradiation, but developed metastases to his lungs (stage 4 cancer) on 16August, year 1, a terminal diagnosis with a poor prognosis. He had beguna regime of antioxidant vitamins and vitamin D in June, year 0, and, onSeptember 23, year 1, he began taking the NSAID Celebrex 100 mg twiceper day. In March, year 3, he began PVF vaccine three times per week,which he continued till April, year 4 at which time he developed brainmetastases, which lead to his death on June 2, year 4, almost 3 yearsafter a diagnosis of stage 4 terminal colon cancer. PtG livedsubstantially longer than would normally be expected with a diagnosis ofstage 4 colon cancer with metastases to the lungs. In this context, theinvention provides for the use of anti-inflammatory modalities inconjunction with immunogenic compositions, such as PVF, for synergisticeffect.

Patient H (PtH): PtH was diagnosed with colon cancer with metastases tothe liver and lungs on February 13, year 0. On January 11, year 1, hewas prescribed an antioxidant and vitamin D regime. However, in March,year 1, he entered a chemotherapy research study and discontinued thesesupplements at that time at the request of the study coordinators. Hewas not treated with any NSAIDs. On May 12, year 1, he began treatmentwith PVF, which he took three times per week until his death just 2.5months later. When contrasted to similar cases that involved the use ofanti-infammatories, this case illustrates that, if adjuvantanti-inflammatory modalities are not given concomitantly with thetargeted antigenic activation therapy, there is a lack of a synergisticeffect that would otherwise occur with concomitant use of adjuvantanti-inflammatory modalities.

In summary, in cases of stage 4 colon cancer treated with targeted PVFvaccine therapy, the use of adjuvant anti-inflammatory agents, includingantioxidants, vitamin D and Celebrex, used in conjunction with targetedantigenic activation therapy, was associated with substantially improvedsurvival, much greater than that of the two cases in which theseadjuvant anti-inflammatory modalities were not used in conjunction withthe vaccine, providing evidence suggestive of a synergistic effect.

PVF with and without Anti-Inflammatories for Cancer of the Pancreas withMetastases to the Lungs, Liver and Abdominal Lymph Nodes

Patient I (PtI): PtI was diagnosed with pancreatic cancer in August,year 1, at which time he had surgery to remove his pancreas (i.e.,Whipple's procedure). However, in July year 2, he developed metastasesto the lungs bilaterally and in February year 4 he developed recurrenceof cancer in the pancreatic area with abdominal and liver metastases.This is a terminal diagnosis with a very poor prognosis. PtI began aregime of antioxidant vitamins, vitamin D, large doses of turmeric(curcumin), fish oil (9 gm per day), resveratrol and green tea(equivalent of 36 cups per day) on September 27, year 2, all of whichare anti-inflammatory modalities, all of which he continued to take. InMarch year 3, he began treatment with Celebrex 100 mg twice per day,which he took for more than 20 months. PtI began treatment with PVFthree times per week in May year 4, which he has continued to useregularly for more than 3 years. PtI survived for 5 years after adiagnosis of terminal metastatic pancreatic cancer, a remarkablyprolonged survival in the context of a diagnosis that has an extremelypoor prognosis. This case provides evidence that high doses of multipleanti-inflammatory modalities (i.e., Celebrex, antioxidants, vitamin D,turmeric, fish oil, resveratrol, green tea) taken in conjunction withthe PVF compositions, resulted in a synergistic effect which hascontributed to PtI's remarkable survival for 5 years after developingmetastatic pancreatic cancer, a diagnosis that is usually fatal within 6months.

In accordance with the foregoing results, one aspect of the inventioninvolves the treatment of cancer of the pancreas, abdominal lymph nodes,liver and lung with administration of antigenic compositions thatcomprise antigenic determinants of microbial pathogens that are known tocause infection in the pancreas, abdominal lymph nodes, liver and lungs.

Patient J (PtJ) had an essentially identical diagnoses to PtI (i.e.,pancreatic cancer with metastases to abdominal lymph nodes, lungs andliver). PtJ, who did not take any other anti-inflammatories along withthe PVF vaccine except antioxidants and vitamin D, died within 4 monthsof diagnosis, whereas PtI, who took large doses of numerous otheranti-inflammatories modalities (i.e., Celebrex, turmeric, fish oil,resveratrol and green tea) in conjunction with PVF vaccine, survived for5 years after diagnosis. These cases provide evidence of a synergisticeffect of high dose multiple anti-inflammatory modalities and targetedvaccine therapy.

MRV for Cancer of the Breast with Metastases to the Bone

Patient K (PtK): In March, year 0, PtK developed neck and back pain,which persisted. On July 28, year 0, she was diagnosed with stage 4breast cancer with metastases to the cervical spine, an incurablediagnosis. She underwent surgery to remove two breast lumps (axillarylymph nodes positive) and palliative radiation to the metastases in herspine. On January 18, year 1, PtK began treatment with doses ofantioxidants and vitamin D, as well as the NSAID indomethicin 50 mg fourtimes per day. Three days later, on January 21, year 1, she begantreatment with the MRV composition, which contains Staphylococcus aureusthe most common pathogen of both the breast and bone. Although there wasno documentation of the exact length of time that treatment with thiscombination of MRV/indomethicin/antioxidant/vitamin D was continued, thepatient was given sufficient vaccine (20 ml) for approximately 2 yearsof treatment at the usual dose and frequency (i.e., three times perweek) and PtK stated that she completed the recommended treatment courseat home. Remarkably, PtK was still alive at last contact, 13 years afterdiagnosis with stage 4 metastatic breast cancer with metastases to bone.

In accordance with the foregoing results, one aspect of the inventioninvolves the treatment of cancers of the breast and bone withadministration of antigenic compositions that comprise antigenicdeterminants of microbial pathogens that are known to be pathogenic inthe breast and bone infection.

In contrast to Patient K, Patient L (PtL) was diagnosed with breastcancer with metastases to bone on October 11, year 0. She was notprescribed an NSAID or other anti-inflammatories. PtL began treatmentwith MRV on February 27, year 1. She died 9 months later on November 4,year 1, just over one year after diagnosis with stage 4 breast cancerwith metastases to bone. The contrast between the otherwise similarcases of PtK and PtL illustrates the potential for synergistic treatmentwith anti-inflammatories and the antigenic compositions of theinvention.

MRV with and without Anti-Inflammatories for Cancer of the Breast withMetastases to the Bone

Patient M (PtM): PtM was diagnosed with stage 4 breast cancer withmetastases to bone on June 15, year 0. She began on the NSAID Naprosyn250 mg twice per day on an ongoing basis for pain relief and, inOctober, year 3, she began doses of antioxidants and vitamin D. Threemonths later, on January 15, year 4, she began treatment with MRVvaccine (which contains Staphylococcus aureus, the most common breastand bone pathogen) in combination with these anti-inflammatory therapies(i.e., Naprosyn, antioxidants and vitamin D). PtM lived for more than 9years after being first diagnosed with stage 4 metastatic breast cancerwith metastases to bone, an unusually long survival considering theusual poor prognosis associated with this diagnosis.

In accordance with the foregoing results, one aspect of the inventioninvolves the treatment of cancers of the breast and bone withadministration of antigenic compositions that comprise antigenicdeterminants of microbial pathogens that are known to be common causesof breast and bone infection.

In contrast to PtM, Patient N (PtN): PtN was diagnosed with stage 4cancer with metastases to bone on April 8, year 0. She began doses ofantioxidants and vitamin D on April 24, year 0. However, prior tostarting MRV, she was prescribed the blood thinner warfarin, limitingsupplementation with vitamin E and vitamin C, two important antioxidantsthat can lead to potential complications if used in conjunction withwarfarin. In addition, NSAIDs could not be prescribed in this case sincethey are contraindicated with warfarin use. On June 2, year 1 PtN begantreatment with MRV. She died 14 months later in August, year 2. In thiscontext, it is possible that the use of targeted vaccine therapy withoutthe synergistic effect of adjuvant anti-inflammatories (i.e., NSAID,vitamin E and therapeutic doses of vitamin C) limited its potentialbenefit.

In summary, in the cases of stage 4 breast cancer with metastases to thebone treated with targeted MRV therapy detailed above, the use ofadjuvant anti-inflammatory agents in conjunction with MRV was associatedwith substantially improved survival, much greater than that of the twocases in which these adjuvant anti-inflammatory modalities were not usedin conjunction with the vaccine, providing evidence suggestive of asynergistic effect.

MRV for Metastases to the Lungs

Patient O (PtO) was diagnosed in June, year 0 with kidney cancer withmetastases to the lungs bilaterally and to the bone (left femur). Thisis generally considered to be an incurable terminal diagnosis with apoor prognosis. He began treatment with the MRV on August 10, year 0 andcontinued regular treatment (three times per week) for 16 months (afterwhich MRV was no longer available). In September, year 0, he began 7months of treatment with an experimental drug, pegylated interferonalpha-2a. His left femur was ‘pinned’ due to the risk of fracture as aresult of the metastasis but, due to surgical complications, amputationof the left leg below the mid-thigh was required. In September, year 2,his cancerous right kidney was removed. In October, year 2, a PET scanfound no evidence of cancer in the lungs and no further evidence of bonemetastases. PtO is alive with no evidence of cancer in his lungs, morethan 9 years after a diagnosis of bilateral pulmonary metastases, aremarkable result.

In accordance with the foregoing results, one aspect of the inventioninvolves the treatment of metastases to the lung with administration ofantigenic compositions that comprise antigenic determinants of microbialpathogens that are known to be lung pathogens.

MRV for Metastases to the Bone and Lungs

Patient P (PtP) was diagnosed with kidney cancer in July, year 0, andunderwent excision of this right kidney. In December, year 4, hedeveloped metastases to the bone (femurs bilaterally) and lungs(bilaterally). PtP declined conventional treatment and began treatmentwith MRV in April, year 5, which he continued regularly, three times perweek, for 18 months. PtP's health improved and he returned to normaldaily activities. X-rays and imaging of the chest and femurs showed noprogression, with stable disease in the lungs and femurs during the 18months that PtP was on MRV treatment.

In accordance with the foregoing results, one aspect of the inventioninvolves the treatment of metastases to the lung and bone withadministration of antigenic compositions that comprise antigenicdeterminants of microbial pathogens that are common causes of lung andbone infection.

MRV for Metastases to the Lungs

Patient Q (PtQ) was diagnosed with colon cancer with probable metastasesto the lungs in June, year 0. At that time, the primary colon tumour wasfully excised, leaving only several lung metastases. PtQ startedtreatment with MRV on December 11, year 0 which she continued threetimes per week for 4 months. On April 19, year 1, after 6 monthstreatment with chemotherapy, she had surgery to excise the only visiblelung lesion remaining, which was confirmed to be a metastatic lesion. Adiagnosis of colon cancer with lung metastases has a poor prognosis,even in the context of chemotherapy followed by surgery to excisevisible metastases. In spite of her original poor prognosis, PtQ remainsin excellent health, with no evidence of cancer more than 10 years afterher initial diagnosis with metastases to the lung and treatment withMRV.

S. aureus Antigens for Breast Cancer with Metastasis to the Bone

Patient R (PtR): In May, year 0, PtR was diagnosed with breast cancerwith metastases to her sternum, femur and cervical spine, an incurablecancer with a poor prognosis. She was treated with radiation andTamoxefen. In May, year 4, she developed an additional area ofmetastasis in her lumbar spine and she began on treatment with Megace.In November, year 4, she began treatment with a vaccine (StaphageLystate vaccine) containing only Staphylococcus aureus, the most commoncause of infection of both the breast and bone and thus, a selectedformulation for the treatment of breast and bone cancer. She continuedregular therapy with this vaccine for 5 years. In spite of a diagnosisof metastatic breast cancer with multiple bone metastases, PtR survivedfor more than 17 years, a remarkable survival in the context ofincurable metastatic breast cancer and a testament to the promise oftargeted vaccine therapy for the treatment of breast cancer.

In accordance with the foregoing results, one aspect of the inventioninvolves the treatment of cancers of the breast and bone withadministration of antigenic compositions that comprise antigenicdeterminants of microbial pathogens that are known to be the most commoncause of the breast and bone infection.

This embodiment illustates that a formulation that includes antigenicdeterminants of only the most frequently pathogenic organism ororganisms for a tissue may provide particular advantages, as is alsoillustrated in the mouse model data set out below. In keeping with this,we have found enhanced effectiveness of Respivax as opposed to MRV intreating cancers situated in the lung, reflecting the fact that theRespivax formulation is somewhat more optimal because it includes higherrelative concentrations of the pathogenic species which most commonlycause lung infection (i.e., 67% of the bacterial cell count of Respivaxis comprised of species that most commonly cause lung infection, whereasonly 30% of the MRV vaccines are comprised of species that most commonlycause lung infection).

In accordance with the foregoing results, one aspect of the inventioninvolves formulating the antigenic compositions such that antigenicdeterminants of microbial pathogens that are known to be the commoncauses of infection are given preferential priority in the proportionsof the formulation, with the most common cause of infection receivingthe greatest preferential priority. For example, the proportion ofantigenic determinants that are derived from pathogens that are known tobe a common cause of infection may be 10, 20, 30, 40, 50, 60, 70, 80,90, 95 or 100%.

Accordingly, in some embodiments, the invention provides antigeniccompositions in which a threshold proportion of antigenic determinantsselected in accordance with the invention are used, relative to anyother antigenic determinants in the composition. For example, antigeniccompositions may have greater than X % of the antigenic determinantstherein derived from pathogenic (or commonly pathogenic, or mostcommonly pathogenic) species, where X may for example be 10, 20, 30, 40,50, 60, 70, 80, 90, 95 or 100 (or any integer value between 10 and 100).For example, at least X % of the antigenic determinants in the antigeniccomposition may be specific for microbial pathogens that are pathogenic(or commonly pathogenic, or most commonly pathogenic) in the specificorgan or tissue of the patient within which the cancer is situated.Using an alternative measure, of the total number of microbial pathogensin the antigenic composition, at least X % may be selected to bemicrobial pathogens that are pathogenic (or commonly pathogenic, or mostcommonly pathogenic) in the specific organ or tissue of the patientwithin which the cancer is situated. In some embodiments, the antigeniccomposition may accordingly consist essentially of antigenicdeterminants of one or more microbial pathogens that are each pathogenicin the specific organ or tissue within which the cancer is situated. Inselected embodiments, the antigenic composition may consist essentiallyor entirely of antigenic determinants of microbial pathogens that arecommonly pathogenic in the specific organ or tissue of the patients withwhich the cancer is situated. In further selected embodiments, theantigenic antigenic composition may consist essentially or entirely ofantigenic determinants of a microbial pathogen (or pathogens) that aremost commonly pathogenic in the specific organ or tissue of the patientswith which the cancer is situated.

In the context of various aspects of the invention, organisms arecharacterized by the frequency with which they are pathogenic. In thiscontext, the invention also relates to the frequency with whichendogenous flora are pathogenic. For clarity, in this regard, thecharacterizations herein of the frequency of pathogenicity, such as thedesignation “commonly pathogenic” relate, in general, to the proportionof infections in a particular organ or tissue that are commonlyattributed to a particular organism, and not to the frequency with whichmicrobial colonization of a tissue is converted to a pathogenicinfection. In North America, the majority of human infections areunderstood to be caused by endogenous organisms, even though theseorganisms commonly are present as part of the endogenous flora withoutcausing infection. For example, while S. pneumonia is a common cause oflung infection (i.e., pneumonia) in humans (and thus, is designated“commonly pathogenic” in the lung), it is nevertheless also true that S.pneumonia is commonly present as part of the endogenous flora of therespiratory tract without causing infection and thus, in the nature ofan endogenous colonization, is not normally pathogenic.

MRV for Multiple Myeloma

Patient S (PtS) was diagnosed with multiple myeloma (stage 3A) in thefall of year 0, with multiple lesions on bone scan, including skull,humeri and pelvis. He was treated with standard chemotherapy (melphalanand prednisone) for 6 months. However, in December year 3, he developeda pathological fracture of his right femur as a result of his disease,which required pinning and local radiation. On April 28, year 4, PtSbegan treatment with MRV, which contains Staphylococcus aureus a commoncause of septicemia, which he continued for more than 13 years untilthis vaccine was no longer available in December year 17. Remarkably,PtS is still alive almost 25 years after being diagnosed with multiplemyeloma, a truly extraordinary outcome considering his ‘terminal’diagnosis.

In accordance with the foregoing results, one aspect of the inventioninvolves the treatment of hematological cancers with administration ofantigenic compositions that comprise antigenic determinants of microbialpathogens that are known to cause septicemia.

In accordance with the forgoing results, and as illustrated in otherpatient case reports detailed herein, another aspect of the inventioninvolves the administration of the immunogenic compositions repeatedlyrelatively frequently over a relatively long period of time, asdescribed elsewhere herein.

PVF for Colon Cancer with Metastases of the Liver and Abdominal LymphNodes

Patient T (PtT) was diagnosed with colon cancer and was treated withexcision of the primary tumour (and subsequent chemotherapy) inSeptember year 0. Ten months later, she developed a liver metastasis,which was surgically excised in July year 1. PtT remained well untilJune year 7, when she was diagnosed with recurrent disease—an inoperablemass of abdominal lymph nodes in close proximity to the aorta and spine,obstructing her left ureter, requiring insertion of a nephrostomy tube.PtT was considered terminal and treated with palliative radiation inOctober year 7. She began treatment with PVF on November 17, year 7,which she continued every second day. PtT survived for almost 4 yearsafter being diagnosed with terminal recurrent metastatic colon cancer.

In accordance with the foregoing results, one aspect of the inventioninvolves the treatment of cancer in abdominal lymph nodes withadministration of antigenic compositions that comprise antigenicdeterminants of microbial pathogens that are known to cause infection inabdominal lymph nodes.

MRV for Metastasis to the Skin and Perineum

Patient U (PtU) was diagnosed with colon cancer and was treated withexcision of the primary tumour in November year 0. He was diagnosed withstage 4 cancer in July year 2 with metastases to the perineum (i.e.,peri-anal/genital soft tissue area) and skin. He had further surgery toremove as much of the cancer as possible in the perineum (cancerextended past surgical margins) with follow-up radiation andchemotherapy. The only known cancer sites remaining were in the skin andperineum. PtU started treatment with MRV, which contains Staphylococcusaureus a common cause of skin and perineal infection, on May 25, year 3,which he continued three times per week for 5 months. In spite of hisoriginal poor prognosis, PtU is in excellent health more than 10 yearsafter his diagnosis with stage 4 cancer with metastases to the perineumand skin.

In accordance with the foregoing results, one aspect of the inventioninvolves the treatment of cancer of the skin and perineum withadministration of antigenic compositions that comprise antigenicdeterminants of microbial pathogens that are known to be common causesinfection in the skin and perineum.

PVF for Metastases to the Peritoneum

Patient V (PtV) was diagnosed with breast cancer in May, year 0, atwhich time she had a masectomy with adjuvant chemotherapy. In January,year 12, she developed abdominal pain and ascites and was diagnosed withperitoneal metastases, a diagnosis with a poor prognosis. On August 5,year 12, PtV began treatment with PVF, which contains E. coli a commoncause of peritoneal infection, which she continued regularly for 1 year.Her tumour markers and ascites decreased and, in August year 13, afterone year of PVF treatment, she had abdominal surgery for an unrelatedmedical condition, at which time the surgeon could not find any evidenceof the previous peritoneal cancer. PtV discontinued use of the vaccine.PtV was still alive at last contact, 3 years and 9 months after beingdiagnosed with terminal peritoneal metastases.

In accordance with the foregoing results, one aspect of the inventioninvolves the treatment of peritoneal metastases with administration ofantigenic compositions that comprise antigenic determinants of microbialpathogens that are known to cause peritoneal infection.

PVF for Ovarian and Pelvic Cancer

Patient W (PtW) was diagnosed with stage 3B poorly differentiatedovarian cancer in the fall of year 0. She had surgery in November year0, with removal of the left ovary, but the cancer could not becompletely excised and thus, she was at extreme risk for recurrence. Shehad a full course of post-operative chemotherapy. However, in year 2 hertumour markers began to rise and in January year 3 she was diagnosedwith a recurrence in her right ovary area. She had surgery to removethis right ovarian mass in February year 3, but again the cancer couldnot be completely excised and she had follow-up chemotherapy. However,once again in December year 3 she developed a further recurrence in thepelvic area and retroperitoneal lymphadenopathy. She began treatmentwith PVF vaccine, which contains E. coli a cause of ovarian and pelvicinfection, on January 5, year 4, which she continued for 6 months. Hertumour markers, which had risen to 2600, fell to the 300 range. PtW wasalive and feeling very well at last contact, 2 years and 9 months afterbeing diagnosed with recurrent ovarian cancer. Of note is the fall inher tumour markers following PVF treatment.

In accordance with the foregoing results, one aspect of the inventioninvolves the treatment of ovarian and pelvic cancer with administrationof antigenic compositions that comprise antigenic determinants ofmicrobial pathogens that are known to cause infection in the ovary andpelvic areas.

MRV for Follicular Non-Hodgkin's Lymphoma

Patient Y (PtY): was diagnosed with stage 4A Follicular Non-Hodgkin'slymphoma, with extensive marked lymphadenopathy (i.e., enlarged lymphglands). He declined all conventional treatment. PtY began treatmentwith the MRV composition, which contains many of the pathogens whichcommonly cause infection of the lymph nodes of the head and neck,axillae, mediastinum and inguinal areas. In addition, he began treatmentwith a multiple vitamin/supplement regime, healthful diet and otherimmune enhancement treatments. He continued regular use of this vaccinefor more than 3 years, at which time his lymph glands had begun togreatly reduce in size and he was feeling well. This resolution oflymphadenopathy continued, and imaging showed almost complete resolutionof previous extensive lymphadenopathy. PtY was feeling well and therewas no lymphadenopathy palpable: a clearly remarkable recovery. Fiveyears after his initial diagnosis with Stage 4A Follicular Non-Hodgkin'slymphoma, PtY had no evidence of recurrence and was leading an activeand healthy life. Treatment with MRV vaccine resulted in completeremission of his stage 4A follicular non-Hodgkins' lymphoma.

In accordance with the foregoing results, one aspect of the inventioninvolves the treatment of lymphoma with administration of antigeniccompositions that comprise antigenic determinants of microbial pathogensthat are known to be common causes of lymph node infection in the regionthe lymphoma is located.

PVF for Colon Cancer with Metastases to the Liver and Kidneys

Patient Z (PtZ) was diagnosed with metastatic spread of previouslytreated colon cancer, with a metastasis to the liver and probable othermetastases to both kidneys. The liver metastasis was excised. Theprognosis for this stage (i.e., stage 4) of colon cancer is poor and thebenefit of further conventional treatment (i.e., chemotherapy) islimited. PtZ declined chemotherapy initially. Three months afterdiagnosis with metastatic colon cancer, PtZ began treatment withPolyvaccinum Forte (PVF), which contains E. coli, a common cause ofinfection of the colon, liver and kidneys. In addition PtZ begantreatment with a multiple vitamin/supplement regime and healthful diet.He continued regular use of this vaccine and the vitamin and supplementregime, and began chemotherapy. Although the overall course of hisdisease was slowly progressive, with development of lung metastases andrecurrence of liver metastases, 28 months after his initial diagnosis ofmetastatic disease, his weight was stable and his energy levels weregood. Three years (36 months) after diagnosis of stage 4 colon cancer,PtZ was feeling well except for nausea and mild weight loss related tochemotherapy.

In accordance with the foregoing results, one aspect of the inventioninvolves the treatment of cancer of the colon, liver and kidneys withadministration of antigenic compositions that comprise antigenicdeterminants of microbial pathogens that are known to be pathogenic inthe colon, liver and kidneys.

PVF for Colon Cancer with Metastases to the Liver, Porta Hepatic LymphNodes and Lung

Patient AA (PtAA) was diagnosed with metastatic colon cancer withmetastases to the liver, portahepatic lymph nodes and lungs. Theprognosis for this stage (i.e., stage 4) of colon cancer is very poor(i.e., ‘terminal’ cancer) and the benefit of conventional treatment(i.e., chemotherapy) is limited. PtAA began chemotherapy, butdiscontinued treatment approximately 5 months after his diagnosis due toside effects, at which time he began treatment with Polyvaccinum Forte(containing bacterial species which cause infection in the colon, liver,abdominal lymph nodes and lungs) every second day as well as a multiplevitamin/supplement regime and a healthy diet. PtAA's subsequent CT Scansdemonstrated necrotic porta hepatic lymph nodes unchanged in size fromthe time of his diagnosis and no change in size of the lung metastases,although the two liver metastases grew moderately in size (3.4 cm to 4.5cm and 1.2 cm to 3.0 cm). In spite of the very poor prognosis, PtAAcontinued to feel quite well almost one year after a diagnosis ofterminal cancer.

In accordance with the foregoing results, one aspect of the inventioninvolves the treatment of cancer of the colon, liver, abdominal lymphnodes and lungs with administration of antigenic compositions thatcomprise antigenic determinants of microbial pathogens that are known tobe pathogenic in the colon, liver, abdominal lymph nodes and lungs.

Example 3 Microbial Pathogens

In alternative aspects, the invention utilizes microbial antigens, suchas bacterial or viral antigens, to formulate antigenic compositions,where the microbial species is selected on the basis of the tissue ororgan within which the microbe is known to cause infections. Bacterialresident flora are the most common bacterial pathogens, accounting forthe vast majority of bacterial infections in most animals, includinghumans. Resident flora can for example infect through primaryattachment, or attachment and invasion following mucosa damage,resulting for example from vascular, trauma, chemical insult, or damageresulting from primary infection.

For microbial pathogens, virulence and infection potential is acombination of the ability of the microbe to adhere, to produce enzymes,to survive immunoproducts (complement, antibody) and to survive themicrobiocidal activity of macrophage and neutrophils. Some bacteria,including endogenous bacteria, may be sufficiently virulent as to causemonomicrobial infections, while others are more effective with thesynergy of polymicrobial infection. In general, it is often not possibleto be precise about the specific role of individual microbes within themilieu of mixed infection. As acute infection may, in some cases,provide more optimal immune stimulation, accordingly, in someembodiments, the invention utilizes microbial species that are involvedin acute infection.

In some embodiments, bacteria that are members of the endogenous floraof a particular region may be used to formulate antigenic compositionsof the invention. The rows of Table 1 list a number of bacterialspecies, together with the biological regions in which each species mayform a part of the endogenous flora. For example, Abiotrophia spp. aretypically members of the endogenous flora of the respiratory tract andthe mouth.

TABLE 1 Human Bacterial Normal Flora (Endogenous Bacterial HumanPathogens) Duodenum/ GU Bacterial species Respiratory Mouth StomachJejunum Ileum Colon System Genital Skin CFL/mL 10{circumflex over ( )}510{circumflex over ( )}2 10{circumflex over ( )}5 10{circumflex over( )}8 10{circumflex over ( )}11 Abiotrophia spp + + Acholeplasma + +laidlawii Acidaminococcus + + + + + fermentans Acinetobacterspp. + + + + + + + + Actinobacillus spp. + + Actinobaculumspp. + + + + + Actinomyces spp. + + + + + + + Aerococcus + christenseniiAerococcus viridans + Aerococcus urinae + Aeromonas spp. + + +Alloiococcus otitis + Anaerorhabdus + + furcosus Anaerococcus + + + +hydrogenalis Anaerococcus + + + lactolyticus Anaerococcus + + + prevotiiArcanobacterium spp. + + Atopobium spp. + + + + + Bacillus spp. + + +Bacteroides caccae + + Bacteroides + + distasonis Bacteroideseggerthii + + Bacteroides fragilis + + + + Bacteroides merdae + +Bacteroides ovatus + + Bacteroides + + splanchnicus Bacteroides + +thetaiotaomicron Bacteroides vulgatus + + Bifidobacterium + + +adolescentis Bifidobacterium + + + + + bifidum Bifidobacterium + + + + +breve Bifidobacterium + + + + + catenulatumBifidobacterium + + + + + + + dentium Bifidobacterium + + + + + longumBilophila + + + + + + + wadsworthia Brevibacterium casei +Brevibacterium + epidermidis Burkholderia cepacia + + + +Butyrivibrio + + + fibrisolvens Campylobacter + + + + concisusCampylobacter + + + + curvus Campylobacter + + + + gracilisCampylobacter jejuni + + + Campylobacter + + + rectusCampylobacter + + + + + showae Campylobacter + + sputorumCapnocytophaga + + granulosum Capnocytophaga + + gingivalisCampylobacter + + haemolytica Capnocytophaga + + + + + + + ochraceaCapnocytophaga + + sputigena Cardiobacterium + + hominis Cedecea spp +Centipeda periodontii + + Citrobacter freundii + + + Citrobacterkoseri + + + Clostridium spp. + + + Corynebacterium + + + accolensCorynebacterium + + + afermentans Corynebacterium + amycolatumCorynebacterium + auris Corynebacterium + + diphtheriaeCorynebacterium + durum Corynebacterium + glucuronolyticumCorynebacterium + jeikeium Corynebacterium + macginleyiCorynebacterium + matruchotii Corynebacterium + minutissimumCorynebacterium + propinquum Corynebacterium + pseudodiphtheriticumCorynebacterium + riegelii Corynebacterium + simulansCorynebacterium + + striatum Corynebacterium + ulceransCorynebacterium + + urealyticum Dermabacter hominis + Dermacoccus +nishinomiyaensis Desulfomonas pigra + + + Dysgonomonas spp. + + +Eikenella corrodens + + + + + Enterobacter + + + aerogenes Enterobactercloacae + + + Enterobacter + + + gergoviae Enterobacter + + + sakazakiiEnterobacter + + + taylorae Enterococcus spp. + + + Escherichiacoli + + + + + Escherichia + + + fergusonii Escherichia + + + hermanniiEscherichia vulneris + + + Eubacterium spp. + + + + + Ewingellaamericana + + Finegoldia magnus + + + + + Fusobacterium alocis + +Fusobacterium + + + + + gonidiaformans Fusobacterium + + + mortiferumFusobacterium + + + + + naviforme Fusobacterium + + + + + necrophorumFusobacterium + + nucleatum Fusobacterium sulci + + Fusobacteriumrussii + + + Fusobacterium + + + varium Gardnerella + + + + + vaginalisGemella haemolysans + + Gemella morbillorum + + + + + Globicatellaspp. + + Granulicatella spp. + + Haemophilus spp. + + + Hafniaalvei + + + Helcococcus kunzii + Helicobacter spp. + + + Kingellaspp. + + Klebsiella spp. + + + + + Kocuria spp. + Kytococcus +sedentarius Lactobacillus + + + + + + + + acidophilus Lactobacillusbreve + + Lactobacillus casei + + + + Lactobacillus + + cellobiosusLactobacillus + + + + + + + + fermentum Lactobacillus reuteri + + + +Lactobacillus + + + + + + salivarius Lactococcus spp. + +Leclercia + + + adecarboxylata Leminorella spp. + + + Leptotrichiabuccalis + + + + Leuconostoc spp. + + Megasphaera + + + elsdeniiMicrococcus luteus + + + Micrococcus lylae + + + Micromonas micros + +Mitsuokella + + + multiacidus Mobiluncus curisii + + + + Mobiluncusmulieris + + + + Moellerella + + + wisconsensis Moraxella + +catarrhalis other Moraxella spp. + + + + Morganella morganii + + +Mycoplasma buccale + + Mycoplasma faucium + Mycoplasma + + + fermentansMycoplasma + + genitalium Mycoplasma hominis + + + Mycoplasma + +lipophilum Mycoplasma orale + + Mycoplasma + penetrans Mycoplasma + +pneumoniae Mycoplasma + primatum Mycoplasma + + salivarium Mycoplasma +spermatophilum Neisseria cinerea + Neisseria flavescens + Neisserialactamica + Neisseria + + meningitidis Neisseria mucosa + Neisseria +polysaccharea Neisseria sicca + Neisseria subflava + Oligellaureolytica + + Oligella urethralis + + Pantoea agglomerans + + +Pastuerella bettyae + + Pasteurella + + multocida Pediococcus spp. + +Peptococcus niger + + + Peptoniphilus + + + + + + asaccharolyticusPeptoniphilus + lacrimalis Peptostreptococcus + + + + + anaerobusPeptostreptococcus + + + productus Peptostreptococcus + + + vaginalisPorphyromonas + + + + + + asaccharolytica Porphyromonas + + + catoniaePorphyromonas + + + endodontalis Porphyromonas + + + gingivalisPrevotella bivia + + Prevotella buccae + + + Prevotellabuccalis + + + + + Prevotella corporis + + + Prevotella dentalis + + +Prevotella denticola + + + Prevotella disiens + + Prevotellaenoeca + + + Prevotella + + + heparinolytica Prevotella intermedia + + +Prevotella loescheii + + + + + Prevotella + + + + + melaninogenicaPrevotella nigrescens + + + Prevotella oralis + + + + + Prevotellaoris + + + Prevotella oulorum + + + Prevotella tannerae + + + Prevotellaveroralis + + + + + Prevotella + + + zoogleoformans Propionibacterium +acnes Propionibacterium + avidum Propionibacterium + granulosumPropionibacterium + + propionicum Propionferax + innocuum Proteusmirabilis + + + Proteus penneri + + + Proteus vulgaris + + + Providenciarettgeri + + Providencia stuartii + + + Pseudomonas + + + aeruginosaRetortamonas + + + intestinalis Rothia dentocariosa + + Rothiamucilaginosa + + Ruminococcus + + + productus Selenomonas spp. + +Serratia liquefaciens + + Serratia marcescens + + Serratia odorifera + +Staphylococcus + + + + + aureus Staphylococcus + auricularisStaphylococcus + capitis Staphylococcus + caprae Staphylococcus + cohniiStaphylococcus + + + + + epidermidis Staphylococcus + haemolyticusStaphylococcus + hominis Staphylococcus + lugdunensis Staphylococcus +pasteuri Staphylococcus + saccharolyticus Staphylococcus + +saprophyticus Staphylococcus + schleiferia Staphylococcus + simulansStaphylococcus + xylosus Staphylococcus + warneriStreptococcus + + + + + agalactiae Streptococcus + + + + + + + anginosusStreptococcus bovis + + + Streptococcus + + + + + + + constellatusStreptococcus criceti + + Streptococcus crista + + Streptococcus + +equisimilis Streptococcus + + gordonii Streptococcus + + + + + +intermedius Streptococcus mitis + + + Streptococcus mutans + +Streptococcus oralis + + Streptococcus + + parasanguis Streptococcus +pneumoniae Streptococcus + + + + pyogenes Streptococcus + + + salivariusStreptococcus + + + sanguis Streptococcus + + sobrinus Streptococcus + +vestibularis Group C + G + + Streptococci Succinivibrio + + +dextrinosolvens Sutterella spp. + + + + + Suttonella + + indologenesTissierella praeacuta + + + Treponema denticola + + Treponema + +maltophilum Treponema minutum + Treponema + phagedenis Treponema +refringens Treponema + + socranskii Treponema vincentii + + Turicellaotitidis + Ureaplasma + + + urealyticum Veillonella spp. + + + + +Weeksella virosa + +

Endogenous microbial flora, such as bacteria, have access to tissues forpathogenesis either through contiguous spread or bacteremic spread.Under favorable conditions, all endogenous organisms can becomepathogenic and invade locally and spread by contiguous spread toadjacent tissues and organs. Endogenous bacterial flora of the skin,mouth and colon are the species that are understood to also be amenableto bacteremic spread. Bacteria that are members of a particularendogenous flora domain may therefore cause infection in tissues ororgans to which these bacteria may spread. Accordingly, one aspect ofthe invention involves the use of endogenous microbial pathogens totreat a cancer of a tissue or organ to which the endogenous bacteria mayspread to cause infection. The columns of Table 2 list 9 domains forendogenous flora, the: skin, respiratory system, genitals, GU system,mouth, stomach, duodenum/jejunum, ileum and colon. The rows of Table 2list organs or tissues within which cancers may be situated.Accordingly, one aspect of the invention involves the use of endogenousmicrobial pathogens to formulate antigenic compositions, or theselection of existing formulations having the pathogens, for treatingcancers situated in tissues or organs to which the pathogen may spreadto cause an infection. Accordingly, in alternative embodiments, tumorssituated in the tissues or organs listed in the first column of Table 2may be treated with antigenic compositions comprising antigenicdeterminants that are specific for microbial pathogens that are membersof the endogenous flora of one or more of the endogenous flora domainslisted in the first row of Table 2 and indicated with an X or a checkmark in the appropriate row. For example, tumors situated in theprostate may be treated with an antigenic composition having antigenicdeterminants specific for a microbial pathogen or pathogens endogenousto the GU system and/or genital system. A number of the bacterialspecies that are endogenous to the endogenous flora domains listed inTable 2 are listed, with the corresponding endogenous flora domains, inTable 1. Accordingly, one aspect of the invention involves the treatmentof a cancer situated in a tissue listed in Table 2 with an antigeniccomposition comprising antigenic determinants of the bacterial speciesthat are listed in Table 1, where the regions of endogenous flora linkedto the site of the tumor in Table 2 match the regions of endogenousflora linked to the bacterial species in Table 1.

TABLE 2 Tissue/Organ Pathogenicity of Endogenous Flora Tissue/organ GUDuodenum/ site Skin Respiratory Genital System Mouth Stomach JejunumIleum Colon Skin X X Soft tissue X (i.e. fat and muscle) (e.g., sarcoma)Breast X X Lymph X X X nodes: head and neck Lymph X ✓ ✓ nodes:axillae/arm Lymph X ✓ ✓ nodes: mediastinal Lymph X nodes: pulmonaryhilum Lymph X ✓ X X X X nodes: intra- abdominal Lymph X X ✓ ✓ nodes:inguinal/leg Hematological ✓ ✓ ✓ (e.g. leukemias, multiple myeloma) BoneX ✓ ✓ Meninges X X Brain ✓ ✓ ✓ Spinal cord ✓ ✓ ✓ Eye/Orbit X X X XSalivary X glands Oral X Tonsil X X Nasopharynx/ X X Sinus Thyroid ✓ ✓ ✓Larynx X X Lung/Trachea/ X Bronchi Pleura ✓ X ✓ ✓ Mediastinum X Heart ✓✓ ✓ Esophagus X Stomach X Small bowel X X Colon/ X Rectum Anus X XPerineum X X Liver ✓ ✓ ✓ Gallbladder X Biliary tract X Pancreas X Spleen✓ ✓ ✓ Adrenal ✓ ✓ ✓ gland Kidney ✓ X ✓ ✓ Ureter X Bladder ✓ X XPeritoneum X X X X Retroperitoneal X X X X X area Prostate X X TesticleX X Penis X X X Ovary/ X X X Adnexae Uterus X X X Cervix X X X Vagina XX Vulva X X *Bacteria have access to tissues/organs either through:Contiguous spread (X) or Bacteremic spread: (✓).

In accordance with the combined information in Tables 1 and 2, cancerslocated in the tissues or organs set out in column 1 of Table 2 may betreated with antigenic compositions comprising antigenic determinants ofthe corresponding bacterial species of Table 1, so that the columnheadings in Table 2 are in effect replaced with the bacterial species ofTable 1.

In some embodiments, microbial pathogens for use in the invention may beexongenous bacterial pathogens. For example, the organisms listed inTable 3 may be used as microbial pathogens to formulate antigeniccompositions, or antigenic compositions having those pathogens mayselected, for use to treat cancers situated in the tissues or organslisted with the relevant organism in Table 3. In some embodiments,antigenic determinants of both endogenous and exogenous bacterialspecies targeted to a specific tissue or organ may be used incombination. For example, an antigenic composition derived from, orspecific for, Clostridium difficile, may be used to treat a cancersituated in the colon.

TABLE 3 Exogenous Bacterial Human Pathogens, and their Sites ofInfection bacterial species tissue/organ sites Achromobacter spp.hematological, skin, soft tissue, lung/trachea/bronchi, peritoneum,meninges, bile duct, gallbladder, kidney, bladder, ureter Actinomaduraspp. skin, soft tissue, lung/trachea/bronchi, mediastinum, brain, spinalcord, hematological, meninges Aerobacter spp. small bowel, colon,hematological, peritoneum Aerococcus spp. hematological, heart, bone,kidney, bladder, ureter, meninges Alcaligenes spp. lung/trachea/bronchiAnaplasma spp. meninges, hematological, liver, spleen, bone,lung/trachea/bronchi Bacillus anthracis lung/trachea/bronchi, lymphnodes pulmonary hilum, mediastinum, meninges, skin, nasopharynx, tonsil,oral, small bowel, colon, hematological Bacillus cereus colon, eye,hematological other Bacillus spp. hematological, bone, meninges, brain,heart, lung/trachea/bronchi, mediastinum, skin, soft tissue, colon,stomach, small bowel, eye Balneatrix spp. lung/trachea/bronchi,meninges, hematological Bartonella bacilliformis skin, hematological,liver, muscle, lymph nodes Bartonella henselae brain, spinal cord,hematological, skin, liver, bone, pleura, lung/trachea/bronchi,mediastinum, axillary and inguinal lymph nodes, eye Bartonella quintanaskin, hematological, liver, spleen Bergeyella zoohelcum skin, softtissue, meninges, hematological, lung/trachea/bronchi Bordetellaholmesii lung/trachea/bronchi, hematological Bordetella parapertussisnasopharynx, tonsil, lung/trachea/bronchi Bordetella pertussisnasopharynx, tonsil, lung/trachea/bronchi Borrelia burgdorferi meninges,brain, spinal cord, skin, eye, hematological, inguinal/axillary/cervicallymph nodes, muscle, liver, spleen, nasopharynx, lung/trachea/bronchi,testes Borrelia recurrentis brain, spinal cord, hematological, smallbowel, liver, spleen, salivary glands, lung/trachea/bronchi, lymphnodes, eye, skin Brevundimonas spp. peritoneum, hematological, skin,soft tissue Brucella spp. lung/trachea/bronchi, lymph nodes pulmonaryhilum, meninges, brain, spinal cord, lymph nodes, mediastinum, bone,eye, small bowel, colon, liver, biliary tract, kidney, ureter, bladder,hematological, skin, testes, spleen, prostate Burkholderia gladiolihematological, meninges, lung/trachea/bronchi Burkholderia malleilung/trachea/bronchi, skin, soft tissue, liver, spleen, muscle, lymphnodes pulmonary hilum, mediastinal lymph nodes, mediastinum, head andneck lymph nodes, hematological Burkholderia pseudomalleilung/trachea/bronchi, skin, kidney, bladder, ureter, soft tissue, bone,brain, spinal cord, muscle, hematological, prostate, kidney, ureter,meninges Calymmatobacterium granulomatis skin, penis, vulva, softtissue, vagina, cervix, bone, hematological, inguinal lymph nodesCampylobacter coli small bowel, colon Campylobacter fetuslung/trachea/bronchi, small bowel, colon, meninges, brain, peritoneum,bone, gallbladder, ovaries, hematological, heart, kidney, bladder,ureter Campylobacter jejuni colon, hematological, gallbladder, pancreas,bladder, bone, meninges Campylobacter sputorum small bowel, colonCapnoctyophaga canimorsus skin, soft tissue, meninges, hematological,bone, lung/trachea/bronchi, eye Capnoctyophaga cynodegmi skin, softtissue, meninges, hematological, bone, lung/trachea/bronchi, eye CDCgroups EF-4a and EF-4b hematological, eye, skin, soft tissue Chlamydiapneumoniae lung/trachea/bronchi, lymph nodes pulmonary hilum, liver,brain, meninges, skin, thyroid, pancreas, hematological Chlamydiapsittaci lung/trachea/bronchi, lymph nodes pulmonary hilum, mediastinum,liver, brain, meninges, hematological, skin, thyroid, pancreas Chlamydiatrachomatis inguinal lymph nodes, penis, vulva, vagina, cervix, uterus,ovaries and adnexae, peritoneum, prostate, eye Chlamydophila pneumoniaelaryngx, trachea/bronchi, hematological Chromobacterium violaceumhematological, liver, spleen, lung/trachea/bronchi, kidney, bladder,ureter, eye/orbit, bone, brain, meninges, spinal cord Chlamydophilapsittaci lung/trachea/bronchi Chryseobacterium spp. meninges,lung/trachea/bronchi, hematological Clostridium bifermentans smallbowel, colon, stomach, skin, soft tissue, hematological Clostridiumbotulinum colon, small bowel, skin Clostridium difficile colonClostridium indolis small bowel, colon, stomach, skin, soft tissue,hematological Clostridium mangenolii small bowel, colon, stomach, skin,soft tissue, hematological Clostridium perfringens small bowel, colon,stomach, skin, soft tissue, hematological, heart Clostridium sordelliismall bowel, colon, stomach, skin, soft tissue, hematologicalClostridium sporogenes small bowel, colon, stomach, skin, soft tissue,hematological Clostridium subterminale small bowel, colon, stomach,skin, soft tissue, hematological Clostridium tetani skin, soft tissueComamonas spp. hematological, peritoneum, eye Corynebacteriumpseudotuberculosis neck/axillary/inguinal/mediastinal lymph nodes, lymphnodes pulmonary hilum, lung/trachea/bronchi, mediastinum Coxiellaburnetii lung/bronchi/trachea, brain, spinal cord, liver, boneEdwarsiella tarda skin, soft tissue, liver, meninges, small bowel,colon, bone, uterus, ovaries Ehrlichia spp. meninges, brain, spinalcord, hematological, bone, liver, kidney, spleen, lymph nodesErysipelothrix rhusiopathiae skin, hematological, bone, brain,peritoneum Francisella tularensis nasopharynx, oral, tonsil,lung/trachea/bronchi, skin, axillary/head and neck/inguinal lymph nodes,hematological, eye, small bowel Fusobacterium spp. skin, soft tissue,hematological Gordonia spp. skin, soft tissue, lung/trachea/bronchi,mediastinum, brain, spinal cord, hematological, meninges, eyeHaemophilus ducreyi skin, inguinal lymph nodes, penis, vulva, vaginaHelicobacter pylori stomach Legionella spp. lung/trachea/bronchi, lymphnodes pulmonary hilum, hematological, brain, spinal cord, muscle,pancreas Leptospirosis spp. lung/trachea/bronchi, pancreas, meninges,brain, spinal cord, skin, lymph nodes, eye, hematological, nasopharynx,oral, tonsil, kidney, liver, spleen Listeria monocytogeneshematological, brain, meninges, spinal cord, small bowel, colonMethylobacterium spp. hematological, peritoneum, skin, soft tissue, boneMycobacterium avium lung/bronchi/trachea, lymph nodes pulmonary hilum,prostate, pancreas, spleen, skin, neck lymph nodes, esophagus, bone,hematological Mycobacterium bovis colon, small bowel Mycobacteriumkansasii lung/bronchi/trachea, lymph nodes pulmonary hilum, prostate,bone Mycobacterium leprae skin, soft tissues, testes, eye Mycobacteriummarinum skin, soft tissue, bone Mycobacterium scrofulaceum head and necklymph nodes Mycobacterium tuberculosis lung/bronchi/trachea, lymph nodespulmonary hilum, prostate, peritoneum, pancreas, spleen, lymph nodes,small bowel, meninges, brain, spinal cord, kidney, ureter, bladder,muscle, esophagus, colon, testes, eye, ovaries, cervix, vagina, uterus,mediastinum, larynx, skin, hematological, pleura Mycobacterium ulceransskin, soft tissue other Mycobacterium spp. lung/bronchi/trachea, lymphnodes pulmonary hilum, skin, soft tissues, bone, head and neck lymphnodes Myroides spp. kidney, bladder, ureter, skin, soft tissue,hematological Neisseria gonorrhoeae nasopharyx, oral, tonsil, prostate,penis, vagina, cervix, uterus, ovary/adnexae, peritoneum, skin, muscle,bone, liver, hematological, head and neck and inguinal and intra-abdominal lymph nodes, anus Neorickettsia sennetsu hematological, bone,lymph nodes, liver, spleen Nocardia spp. lung/bronchi/trachea, pancreas,meninges, spinal cord, brain, skin, soft tissue, eye, bone, kidney,heart, hematological Orientia tsutsugamushi meninges, brain, spinalcord, hematological, skin, inguinal and axillary lymph nodes, spleen,lung/bronchi/trachea Pandoraea spp. lung/trachea/bronchi, hematologicalPasteurella canis skin, soft tissue, hematological Pasteurella dagmatisskin, soft tissue, hematological Pasteurella stomatis skin, soft tissue,hematological Pediococcus spp. hematological, liver, colon Pityrosporumovale skin Plesiomonas shigelloides small bowel, colon, hematological,meninges, bone, gall bladder, skin, soft tissue Pseudomonas aeruginosalung/trachea/bronchi, hemaotogical, skin, soft tissue, bone, meninges,brain, eye, kidney, bladder, ureter, heart other Pseudomonas spp. skin,soft tissue, lung/trachea/bronchi, mediastinum, hematological Ralstoniaspp. hematological, meninges, bone Rhizobium spp. hematological,peritoneum, eye, kidney, bladder, ureter Rhodococcus spp.lung/trachea/bronchi, hematological, brain, skin, lymph nodes, bone,mediastinum, liver, spleen, soft tissue, spinal cord, meningesRickettsia akari skin Rickettsia conorii lung/bronchi/trachea, lymphnodes pulmonary hilum, meninges, brain, spinal cord, hematolofical,skin, kidney, liver, spleen, pancreas Rickettsia felis skin, brain,spinal cord Rickettsia prowazekii meninges, brain, spincal cord,hematological, lung/bronchi/trachea, skin, spleen Rickettsia rickettsiaelung/bronchi/trachea, lymph nodes pulmonary hilum, meninges, brain,spinal cord, hematological, muscle, small bowel, liver, skin Rickettsiaslovaca skin, head and neck lymph nodes Rickettsia typhi meninges,hematological, liver, kidney, brain, lung/bronchi/trachea, spleenRoseomonas spp. hematological, peritoneum, skin, soft tissue, bladder,kidney, ureter Salmonella spp. lung/bronchi/trachea, pancreas, spleen,intra-abdominal lymph nodes, stomach, small bowel, colon, meninges,skin, muscle, bone, hematological, heart Shewanella spp. skin, softtissue, eye, bone, hematological, peritoneum Shigella boydii colonShigella dysenteriae colon Shigella flexneri colon Shigella sonnei colonSphingobacterium spp. brain, meninges, spinal cord, eye, skin, softtissue Sphingomonas spp. hematological, meninges, peritoneum, skin, softtissue, kidney, bladder, ureter Spirillum minus skin,axillary/inguinal/neck lymph nodes, hematological, liver, spleen otherSpirillum spp. colon Stenotrophomonas maltophilia meninges,hematological, peritoneum, lung/trachea/bronchi, eye, kidney, bladder,ureter, skin, soft tissue Streptobacillus moniliformis skin, bone,hematological, lung/trachea/bronchi, meninges, brain, liver, spleenStreptococcus iniae skin, hematological, soft tissue Streptococcuszooepidemicus small bowel, nasopharynx, bone, meninges, hematological,head and neck lymph nodes Streptomices spp. skin, soft tissue,lung/trachea/bronchi, mediastinum, brain, spinal cord, hematological,meninges Treponema pallidum nasopharynx, tonsil, oral, meninges, brain,spinal cord, penis, vulva, vagina, anus, cervix, eye, hematological,inguinal and head and neck lymph nodes Tropheryma whipplei brain, spinalcord, hematological, small bowel, colon, heart, lung/trachea/bronchi,eye Tsukamurella spp. skin, soft tissue, lung/trachea/bronchi,mediastinum, brain, spinal cord, hematological, meninges Vibrio choleraecolon, small bowel Vibrio cincinnatiensis hematological, meninges Vibriodamsela skin, soft tissue Vibrio fluvialis small bowel, colon Vibriofurnissii small bowel, colon Vibrio hollisae small bowel, colon, skin,soft tissue Vibrio metschnikovii hematological Vibrio parahaemolyticuscolon, small bowel Vibrio vulnificus soft tissue, blood, skin Yersiniaenterocolitica nasopharynx, tonsil, small bowel, intra-abdominal lymphnodes, colon, muscle, lung/trachea/bronchi, liver, spleen, hematologicalYersinia pestis lung/trachea/bronchi, lymph nodes pulmonary hilum,inguinal/axillary/neck lymph nodes, oral, tonsil, hematological, skinYersinia pseudotuberculosis small bowel, colon, abdominal lymph nodes

In some embodiments, microbial pathogens for use in the invention may beviral pathogens. Table 4 provides an exemplary list of viral pathogenstogether with the tissue and organ sites for which each viral species isreportedly a pathogen. Accordingly, one aspect of the invention involvesutilizing immunogenic compositions that are specific for the namedviruses to treat a cancer situated in the organs or tissues that areidentified adjacent to the name of the virus in Table 4. For example, anantigenic composition derived from, or specific for, a vaccinia virus,may be used to treat a cancer situated in the skin, hematologicaltissues, lymph nodes, brain, spinal cord, eye or heart.

TABLE 4 Viral Human Pathogens and Their Sites of Infection virustissue/organ sites Vaccinia skin, hematological, lymph nodes, brain,spinal cord, eye, heart Variola (smallpox) skin, hematological, lymphnodes, brain Monkeypox skin, hematological, head and neck lymph nodes,brain, eye, lung/trachea/bronchi, pulmonary hilar lymph nodes,mediastinum, nasopharynx Cowpox skin, hematological, lymph nodesParapoxviruses skin Molluscum contagiosum skin Tanapox skin,hematological, axillary and inguinal lymph nodes Herpes Simplexnasopharynx, oral, tonsil, hematological, virus (1 and 2)lung/bronchi/trachea, pancreas, meninges, brain, spinal cord, inguinaland head/neck lymph nodes, penis, vulva, perineum, esophagus, liver,eye, skin, rectum, tonsil, mediastinum, anus, vagina, cervixVaricella-zoster nasopharynx, sinus, lung/trachea/bronchi, pulmonaryhilar lymph nodes, hematological, pancreas, meninges, brain, spinalcord, esophagus, liver, eye, skin, heart, mediastinum Cytomegalovirusnasopharynx, lymph nodes, tonsil, hematological, lung/trachea/bronchi,pancreas, abdomincal lymph nodes, brain, spinal cord, esophagus, smallbowel, colon/rectum, eye, liver, heart, skin, mediastinum, esophagusEpstein-Barr virus nasopharynx, tonsil, oral, lymph nodes,hematological, lung, abdomincal lymph nodes, brain, spinal cord,muscles, esophagus, liver, heart, skin, spleen, kidney, muscle, heart,lung/trachea/bronchi, pulmonary hilar lymph nodes, mediastinum Humanherpesvirus 6 skin, hematological, lung/trachea/bronchi, pulmonary hilarlymph nodes, brain, meninges, liver Human herpesvirus 7 skin, brain,liver Human herpesvirus 8 nasopharynx, tonsil, hematological, skin,spleen, head and neck lymph nodes Simian herpes B virus brain, spinalcord, skin, hematological, lymph nodes Adenovirus nasopharynx, oral,larynx, trachea, bronchi, lung, lymph nodes, meninges, brain, spinalcord, small bowel, colon, liver, intra-abdominal lymph nodes,mediastinum, bladder, sinus, hematological, ureter, kidney, bladder,thyroid, heart BK virus kidney Human papillomavirus skin, anus, penis,vulva, cervix, vagina, oral Hepatitis B virus liver, pancreas,hematological Hepatitis D virus liver Parvovirus B19 skin,hematological, nasopharynx, bone, kidney, heart, liver, brain, meningesOrthoreoviruses nasopharynx, small bowel, colon, oral, sinus, lymphnodes, skin, lung/trachea/bronchi, meninges, brain, spinal cord, liverOrbiviruses brain, muscle, hematological, Coltiviruses hematological,skin, muscle, oral, spleen, lymph nodes, meninges, brain Rotavirusessmall bowel, colon, liver, hematological, pancreas, nasopharynx,billiary tract, meninges, brain Alphaviruses brain, spinal cord, smallbowel, colon, hematological, skin, bone Rubella skin, hematological,head and neck lymph nodes, spleen, nasopharynx, bone, brain, tonsil,bronchi, liver, heart Yellow fever virus hematological, liver,lung/trachea/bronchi, kidney, adrenal gland, spleen, lymph nodes,stomach, kidney Dengue fever virus hematological, lymph nodes, skin,spleen, muscle, liver, brain, nasopharynx Japanese encephalitis virusbrain, hematological, spinal cord West Nile brain, hematological, spinalcord, muscle, lymph nodes, encephalitis virus liver, spleen, pancreas,meninges St. Louis brain, hematological, spinal cord, meninges, muscle,encephalitis virus nasopharynx Tick-borne encephalitis virus brain,hematological, spinal cord, muscle, meninges other Flaviviruseshematological, brain, meninges, bone, muscles, skin, lymph nodesHepatitis C virus hematological, liver Hepatitis G virus liverCoronaviruses nasopharynx, sinus, oral, tonsil, larynx,lung/trachea/bronchi, pulmonary hilar lymph nodes, small bowel, colon,tonsil, hematological Toroviruses small bowel, colon, hematologicalParainfluenza nasopharynx, sinus, tonsil, oral, larynx, viruseslung/trachea/bronchi, pulmonary hilar lymph nodes, meninges,hematological, mediastinum Mumps virus salivary glands, pancreas, brain,spinal cord, liver, testes, hematological, meninges, ovaries, bone,heart, kidney, thyroid, prostate, breast Respiratory syncytial virusnasopharynx, tonsil, sinus, lung/trachea/bronchi, pulmonary hilar lymphnodes, mediastinum, hematological, oral, pleura Human metapneumovirusnasopharynx, lung/trachea/bronchi, pulmonary hilar lymph nodes, tonsil,sinus, mediastinum, hematological, oral, pleura, larynx, eye, skin,small bowel, colon Rubeola nasopharynx, sinus, hematological,lung/trachea/bronchi, pulmonary hilar lymph nodes, intra-abdominal lymphnodes, meninges, brain, spinal cord, liver, spleen, lymph nodes, skin,thymus, eye, oral, heart Hendra virus brain, meninges,lung/trachea/bronchi, kidney, hematological, muscle, Nipah virus brain,meninges, spleen, lymph nodes, thymus, lung/trachea/bronchi, kidneys,brain, spinal cord, meninges, hematological Vesicular stomatitis virushematological, muscle, oral, tonsil, nasopharyngeal, lymph nodes, smallbowel, colon Rabies virus skin, meninges, brain, spinal cord, oral,nasopharynx, salivary glands, hematological Lyssaviruses brain, spinalcord Influenza virus nasopharynx, laryngx, lung/trachea/bronchi,pulmonary hilar lymph nodes, meninges, muscle, hematological,mediastinum, muscle, sinus, tonsil, oral, eye, pleura, brain, spinalcord, salivary glands, thyroid, heart California encephalitis virushematological, brain, meninges Hantaviruses hematological, kidney, eye,skin, oral, muscle, lung/trachea/bronchi other Bunyaviruses brain,hematological, muscle, meninges, spinal cord Lymphocyticchoriomeningitis virus hematological, muscle, lymph nodes, skin, brain,meninges, testes, bone Lassa virus nasopharynx, brain, spinal cord,lung/trachea/bronchi, pulmonary hilar lymph nodes, mediastinum, muscle,testes, eye, heart, Machupo virus brain, meninges, hematological,muscle, eye, skin, lymph nodes, nasopharynx, small bowel, colon Juninvirus brain, meninges, hematological, muscle, eye, skin, lymph nodes,nasopharynx, small bowel, colon Human T-Cell hematological, skin, lymphnodes, muscle, eye, bone, Lymphotropic viruses lung, pulmonary hilarlymph nodes, spinal cord, brain Poliovirus nasopharynx,lung/trachea/bronchi, pulmonary hilar lymph nodes, small bowel, neck andintra-abdominal lymph nodes, colon, hematological, liver, spleen, skin,brain, spinal cord, meninges, heart Coxsackieviruses nasopharynx,larynx, oral, tonsil, lung/trachea/bronchi, pulmonary hilar lymph nodes,mediastinum, pancreas, muscle, brain, meninges, small bowel, neck andintra- abdominal lymph nodes, colon, hematological, spleen, skin, eye,sinus, liver, testes, bone, pleura, salivary glands, heart Echovirusesnasopharynx, oral, tonsil, lung/trachea/bronchi, pulmonary hilar lymphnodes, muscle, brain, meninges, small bowel, neck and intra-abdominallymph nodes, colon, hematological, mediastinum, spleen, skin, eye,sinus, liver, pancreas, testes, bone, salivary glands, heart otherEnteroviruses lung/trachea/bronchi, pulmonary hilar lymph nodes,meninges, brain, skin, heart Hepatitis A virus small bowel, colon,hematological, liver, spleen, brain, spinal cord, gallbladder, pancreas,kidney Rhinoviruses nasopharynx, sinus, oral, tonsil, larynx,lung/trachea/bronchi, pulmonary hilar lymph nodes Noroviruses and otherCaliciviruses small bowel, colon Astroviruses small bowel, colonPicobirnaviruses small bowel, colon Hepatitis E virus liver, smallbowel, colon, hematological

The cumulative information in Tables 1 through 4 provides an extensiveidentification of microbial pathogens that may be used in theformulation of antigenic compositions of the invention, together with anidentification of the tissues or organs in which these organisms arepathogenic, and accordingly identifies the tissues or organs in which acancer is situated that may be treated with the antigenic formulation.

In some embodiments, the microbial pathogen selected for use inantigenic compositions of the invention may be one that is a commoncause of acute infection in the tissue or organ in which the cancer tobe treated is situated. Table 5 identifies bacterial and viral pathogensof this kind, together with the tissues and organs in which theycommonly cause infection. Accordingly, in selected embodiments, a cancerresiding in a tissue identified in the first column of Table 5 may betreated with an antigenic composition that comprises antigenicdeterminants for one or more of the pathogenic organisms listed in thesecond column of Table 5. For example, a cancer residing in the skin maybe treated with an antigenic composition comprising antigenicdeterminants of one or more of the following organisms: Staphylococcusaureus, Beta hemolytic streptococci group A, B, C and G, Corynebacteriumdiptheriae, Corynebacterium ulcerans, Pseudomonas aeruginosa, rubeola,rubella, varicella-zoster, echoviruses, coxsackieviruses, adenovirus,vaccinia, herpes simplex, or parvo B19.

TABLE 5 Common Causes of Acute Infection (Bacterial and Viruses) ForEach Tissue/Organ Site Tissue/organ Common Bacterial or Viral Pathogensof specific site tissue/organ site Skin Staphylococcus aureus, Betahemolytic streptococci group A, B, C and G, Corynebacterium diptheriae,Corynebacterium ulcerans, Pseudomonas aeruginosa rubeola, rubella,varicella-zoster, echoviruses, coxsackieviruses, adenovirus, vaccinia,herpes simplex, parvo B19 Soft tissue (i.e. Streptococcus pyogenes,Staphylococcus aureus, fat and muscle) Clostridium perfringens, otherClostridium spp. (e.g., sarcoma) influenza, coxsackieviruses BreastStaphylococcus aureus, Streptococcus pyogenes Lymph nodes:Staphylococcus aureus, Streptococcus pyogenes head and neckEpstein-Barr, cytomegalovirus, adenovirus, measles, rubella, herpessimplex, coxsackieviruses, varicella-zoster Lymph nodes: Staphylococcusaureus, Streptococcus pyogenes axillae/arm measles, rubella,Epstein-Barr, cytomegalovirus, adenovirus, varicella-zoster Lymph nodes:viridans streptococci, Peptococcus spp., mediastinal Peptostreptococcusspp., Bacteroides spp., Fusobacterium spp., Mycobacterium tuberculosismeasles, rubella, Epstein-Barr, cytomegalovirus, varicella- zoster,adenovirus Lymph nodes: Streptococcus pneumoniae, Moraxella catarrhalis,pulmonary Mycoplasma pneumoniae, Klebsiella pneumoniae, hilumHaemophilus influenza, Chlamydophila pneumoniae, Bordetella pertussis,Mycobacterium tuberculosis influenza, adenovirus, rhinovirus,coronavirus, parainfluenza, respiratory syncytial virus, humanmetapneumovirus, coxsackievirus Lymph nodes: Yersinia enterocolitica,Yersinia pseudotuberculosis, intra-abdominal Salmonella spp.,Streptococcus pyogenes, Escherichia coli, Staphylococcus aureus,Mycobacterium tuberculosis measles, rubella, Epstein-Barr,cytomegalovirus, varicella- zoster, adenovirus, influenza,coxsackieviruses Lymph nodes: Staphylococcus aureus, Streptococcuspyogenes inguinal/leg measles, rubella, Epstein-Barr, cytomegalovirus,herpes simplex Hematological Staphylococcus aureus, Streptococcuspyogenes, (e.g. leukemias, coagulase-negative staphylococci,Enterococcus spp., multiple myeloma) Escherichia coli, Klebsiella spp.,Enterobacter spp., Proteus spp., Pseudomonas aeruginosa, Bacteroidesfragilis, Streptococcus pneumoniae, group B streptococci rubeola,rubella, varicella-zoster, echoviruses, coxsackieviruses, adenovirus,Epstein-Barr, cytomegalovirus, herpes simplex Bone Staphylococcusaureus, coagulase-negative staphylococci, Streptococcus pyogenes,Streptococcus pneumoniae, Streptococcus agalactiae, other streptococcispp., Escherichia coli, Pseudomonas spp., Enterobacter spp., Proteusspp., Serratia spp. parvovirus B19, rubella, hepatitis B MeningesHaemophilus influenzae, Neisseria meningitidis, Streptococcuspneumoniae, Streptococcus agalactiae, Listeria monocytogenesechoviruses, coxsackieviruses, other enteroviruses, mumps BrainStreptococcus spp. (including S. anginosus, S. constellatus, S.intermedius), Staphylococcus aureus, Bacteroides spp., Prevotella spp.,Proteus spp., Escherichia coli, Klebsiella spp., Pseudomonas spp.,Enterobacter spp., Borrelia burgdorferi coxsackieviruses, echoviruses,poliovirus, other enteroviruses, mumps, herpes simplex,varicella-zoster, flaviviruses, bunyaviruses Spinal cord Haemophilusinfluenzae, Neisseria meningitidis, Streptococcus pneumoniae,Streptococcus agalactiae, Listeria monocytogenes, Borrelia burgdorfericoxsackieviruses, echoviruses, poliovirus, other enteroviruses, mumps,herpes simplex, varicella-zoster, flaviviruses, bunyaviruses Eye/OrbitStaphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae,Streptococcus milleri, Escherichia coli, Bacillus cereus, Chlamydiatrachomatis, Haemophilus influenza, Pseudomonas spp., Klebsiella spp.,Treponema pallidum adenoviruses, herpes simplex, varicella-zoster,cytomegalovirus Salivary glands Staphylococcus aureus, viridansstreptococci (e.g., Streptococcus salivarius, Streptococcus sanguis,Streptococcus mutans), Peptostreptococcus spp., Bacteroides spp., andother oral anaerobes mumps, influenza, enteroviruses, rabies OralPrevotella melaninogenicus, anaerobic streptococci, viridansstreptococci, Actinomyces spp., Peptostreptococcus spp., Bacteroidesspp., and other oral anaerobes herpes simplex, coxsackieviruses,Epstein-Barr Tonsil Streptococcus pyogenes, Group C and G B-hemolyticstreptococci rhinoviruses, influenza, coronavirus, adenovirus,parainfluenza, respiratory syncytial virus, herpes simplex SinusStreptococcus pneumoniae, Haemophilus influenza, Moraxella catarrhalis,α-streptococci, anaerobic bacteria (e.g., Prevotella spp.),Staphylococcus aureus rhinoviruses, influenza, adenovirus, parainfluenzaNasopharynx Streptococcus pyogenes, Group C and G B-hemolyticstreptococci rhinoviruses, influenza, coronavirus, adenovirus,parainfluenza, respiratory syncytial virus, herpes simplex ThyroidStaphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniaemumps, influenza Larynx Mycoplasma pneumoniae, Chlamydophila pneumoniae,Streptococcus pyogenes rhinovirus, influenza, parainfluenza, adenovirus,corona virus, human metapneumovirus Trachea Mycoplasma pneumoniaeparainfluenza, influenza, respiratory syncytial virus, adenovirusBronchi Mycoplasma pneumoniae, Chlamydophila pneumoniae, Bordetellapertussis, Streptococcus pneumoniae, Haemophilus influenzae influenza,adenovirus, rhinovirus, coronavirus, parainfluenza, respiratorysyncytial virus, human metapneumovirus, coxsackievirus LungStreptococcus pneumoniae, Moraxella catarrhalis, Mycoplasma pneumoniae,Klebsiella pneumoniae, Haemophilus influenza influenza, adenovirus,respiratory syncytial virus, parainfluenza Pleura Staphylococcus aureus,Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilusinfluenzae, Bacteroides fragilis, Prevotella spp., Fusobacteriumnucleatum, peptostreptococcus spp., Mycobacterium tuberculosisinfluenza, adenovirus, respiratory syncytial virus, parainfluenzaMediastinum viridans streptococci, Peptococcus spp., Peptostreptococcusspp., Bacteroides spp., Fusobacterium spp. measles, rubella,Epstein-Barr, cytomegalovirus Heart Streptococcus spp. (including S.mitior, S. bovis, S. sanguis, S. mutans, S. anginosus), Enterococcusspp., Staphylococcus spp., Corynebacterium diptheriae, Clostridiumperfringens, Neisseria meningitidis, Salmonella spp. enteroviruses,coxsackieviruses, echoviruses, poliovirus, adenovirus, mumps, rubeola,influenza Esophagus Actinomyces spp., Mycobacterium avium, Mycobacteriumtuberculosis, Streptococcus spp. cytomegalovirus, herpes simplex,varicella-zoster Stomach Streptococcus pyogenes, Helicobacter pyloricytomegalovirus, herpes simplex, Epstein-Barr, rotaviruses, noroviruses,adenoviruses Small bowel Escherichia coli, Clostridium difficile,Bacteroides fragilis, Bacteroides vulgatus, Bacteroidesthetaiotaomicron, Clostridium perfringens, Salmonella enteriditis,Yersinia enterocolitica, Shigella flexneri adenoviruses, astroviruses,caliciviruses, noroviruses, rotaviruses, cytomegalovirus Colon/RectumEscherichia coli, Clostridium difficile, Bacteroides fragilis,Bacteroides vulgatus, Bacteroides thetaiotaomicron, Clostridiumperfringens, Salmonella enteriditis, Yersinia enterocolitica, Shigellaflexneri adenoviruses, astroviruses, caliciviruses, noroviruses,rotaviruses, cytomegalovirus Anus Streptococcus pyogenes, Bacteroidesspp., Fusobacterium spp., anaerobic streptococci, Clostridium spp., E.coli, Enterobacter spp., Pseudomonas aeruginosa, Treponema pallidumherpes simplex Perineum Escherichia coli, Klebsiella spp., Enterococcusspp., Bacteroides spp., Fusobacterium spp., Clostridium spp.,Pseudomonas aeruginosa, anaerobic streptococci, Clostridium spp., E.coli, Enterobacter spp. herpes simplex Liver Escherichia coli,Klebsiella spp., Streptococcus (anginosus group), Enterococcus spp.,other viridans streptococci, Bacteroides spp. hepatitis A, Epstein-Barr,herpes simplex, mumps, rubella, rubeola, varicella-zoster,coxsackieviruses, adenovirus Gallbladder Escherichia coli, Klebsiellaspp., Enterobacter spp., enterococci, Bacteroides spp., Fusobacteriumspp., Clostridium spp., Salmonella enteriditis, Yersinia enterocolitica,Shigella flexneri Biliary tract Escherichia coli, Klebsiella spp.,Enterobacter spp., Enterococci spp., Bacteroides spp., Fusobacteriumspp., Clostridium spp., Salmonella enteriditis, Yersinia enterocolitica,Shigella flexneri hepatitis A, Epstein-Barr, herpes simplex, mumps,rubella, rubeola, varicella-zoster, cocsackieviruses, adenovirusPancreas Escherichia coli, Klebsiella spp., Enterococcus spp.,Pseudomonas spp., Staphylococcal spp., Mycoplasma spp., Salmonellatyphi, Leptospirosis spp., Legionella spp. mumps, coxsackievirus,hepatitis B, cytomegalovirus, herpes simplex 2, varicella-zoster SpleenStreptococcus spp., Staphylococcus spp., Salmonella spp., Pseudomonasspp., Escherichia coli, Enterococcus spp. Epstein-Barr, cytomegalovirus,adenovirus, measles, rubella, coxsackieviruses, varicella-zoster Adrenalgland Streptococcus spp., Staphylococcus spp., Salmonella spp.,Pseudomonas spp., Escherichia coli, Enterococcus spp. varicella-zosterKidney Escherichia coli, Proteus mirabilis, Proteus vulgatus,Providentia spp., Morganella spp., Enterococcus faecalis, Pseudomonasaeruginosa BK virus, mumps Ureter Escherichia coli, Proteus mirabilis,Proteus vulgatus, Providentia spp., Morganella spp., Enterococcus spp.Bladder Escherichia coli, Proteus mirabilis, Proteus vulgatus,Providentia spp., Morganella spp., Enterococcus faecalis,Corynebacterium jekeum adenovirus, cytomegalovirus PeritoneumStaphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumonia,Escherichia coli, Klebsiella spp., Proteus spp., Enterococci spp.,Bacteroides fragilis, Prevotella melaninogenica, Peptococcus spp.,Peptostreptococcus spp., Fusobacterium spp., Clostridium spp.Retroperitoneal area Escherichia coli, Staphylococcus aureus ProstateEscherichia coli, Klebsiella spp., Enterobacter spp., Proteus mirabilis,Enterococci spp., Pseudomonas spp., Corynebacterium spp., Neisseriagonorrhoeae herpes simplex Testicle Escherichia coli, Klebsiellapneumoniae, Pseudomonas aeruginosa, Staphylococcus spp., Streptococcusspp., Salmonella enteriditis mumps, coxsackievirus, lymphocyticchoriomeningitis virus Penis Staphylococcus aureus, Streptococcuspyogenes, Neisseria gonorrhoeae, Treponema pallidum herpes simplex,human papillomavirus Ovary/Adnexae Neisseria gonorrhoeae, Chlamydiatrachomatis, Gardenerella vaginalis, Prevotella spp., Bacteroides spp.,Peptococcus spp. Streptococcus spp., Escherichia coli Uterus Neisseriagonorrhoeae, Chlamydia trachomatis, Gardenerella vaginalis, Prevotellaspp., Bacteroides spp., Peptococcus spp., Streptococcus spp.,Escherichia coli Cervix Neisseria gonorrhoeae, Chlamydia trachomatis,Treponema pallidum herpes simplex Vagina Gardenerella vaginalis,Prevotella spp., Bacteroides spp., peptococci spp., Escherichia coli,Neisseria gonorrhoeae, Chlamydia Trachomatis, Treponema pallidum, herpessimplex Vulva Staphylococcus aureus, Streptococcus pyogenes, Treponemapallidum herpes simplex

In selected embodiments, particular microbial pathogens may be suitedfor treatment of particular cancers, examples of selected embodimentsare set out in Table 5. These are exemplary embodiments, and not anexhaustive list of the alternative formulations for use in accordancewith the invention.

The specific microbes which commonly cause infection in a specifictissue or organ may vary by geographical location. For example,Mycobacterium tuberculosis is a more common cause of lung infection insome geographical locations and populations than in others andtherefore, while M. tuberculosis may not be a common lung pathogen insome geographic and population groups it may be a common lung pathogenin others. Table 5 is thus not an exhaustive list of common pathogensfor all geographic locations and population groups. It is understoodthat a clinical microbiologist skilled in the art could determine thecommon pathogenic species in a particular geographic area or populationgroup for a specific tissue or organ site in accordance with theinvention. For veterinary use, there will of course be specificpathogens that are common in selected tissues of selected species, andthis may also vary geographically.

In selected embodiments, the invention involves diagnostic steps toassess a patient's previous exposure to microbial pathogens. Forexample, the diagnostic steps may include taking a medical history ofexposure to selected pathogens, and/or evaluating a patient's immuneresponse to a selected pathogen. For example, a serology test may beconducted to detect antibodies to selected pathogens in a patient'ssera. In connection with this aspect of the invention, antigenicdeterminants of a selected microbial pathogen may be chosen for use inan immunogenic composition on a selected patient based on a diagnosticindication that the patient has had one or more prior exposure(s) to thepathogen, for example by virtue of the presence of antibodies toantigenic determinants of that pathogen in the patient's sera.

In further selected embodiments, the invention involves diagnostic stepsto assess a patient's immunological response to treatment with aselected immunogenic composition. For example, the diagnostic steps mayinclude evaluating a patient's immune response to the antigenicdeterminants of that immunogenic composition, for example using aserological test to detect antibodies to those antigenic determinants.In connection with this aspect of the invention a treatment with aselected immunogenic composition may be continued if the evaluationindicates that there is an active immunological response to theantigenic determinants of that composition, and the vaccine treatmentmay be discontinued, and an alternative treatment with a differentimmunogenic composition may be initiated, if the evaluation indicatesthat there is not a sufficiently active immunological response to theantigenic determinants of the immunogenic composition.

As discussed in the context of Patient R, in selected embodiments, themicrobial pathogen selected for use in antigenic compositions of theinvention may be one that is the most common cause of acute infection inthe tissue or organ in which the cancer to be treated is situated, whichmay provide particular benefit as illustrated by the case of Patient R.For example, for the treatment of bone cancer, Staphylococcus aureuswould be the bacterial species selected; for the treatment of cancer inlung tissue, Streptococcus pneumoniae would be selected; for thetreatment of breast cancer, Staphylococcus aureus would be selected; forthe treatment of kidney or bladder cancer, Escherichia coli would beselected; and for the treatment of colon cancer, Escherichia coli wouldbe the bacterial species selected. It is understood that a clinicalmicrobiologist skilled in the art could determine the most frequentlypathogenic species, bacterial or viral, for each specific tissue ororgan in accordance with the invention. In selected embodiments, onlyantigenic determinants of the most common pathogen for the particulartissue or organ could be used to treat cancers of that tissue or organ.In alternative embodiments, antigenic determinants of the most commonpathogen for the particular tissue or organ could be used in combinationwith antigenic determinants of other pathogens that are known to bepathogenic in the of that particular tissue or organ, preferentiallyselecting from the more common pathogens.

In some embodiments, the invention provides antigenic compositions inwhich a threshold proportion of antigenic determinants selected inaccordance with the invention are used, relative to any other antigenicdeterminants in the composition. For example, antigenic compositions mayhave greater than X % of the antigenic determinants therein derived frompathogenic (or commonly pathogenic, or most commonly pathogenic)species, where X may for example be 10, 30, 40, 50, 60, 70, 80, 90, 95or 100 (or any integer value between 10 and 100). For example, at leastX % of the antigenic determinants in the antigenic composition may bespecific for microbial pathogens that are pathogenic (or commonlypathogenic or most commonly pathogenic) in the specific organ or tissueof the patient within which the cancer is situated. Using an alternativemeasure, of the total number of microbial pathogens in the antigeniccomposition, at least X % may be selected to be microbial pathogens thatare pathogenic (or commonly pathogenic or most commonly pathogenic) inthe specific organ or tissue of the patient within which the cancer issituated. In some embodiments, the antigenic composition may accordinglyconsist essentially of antigenic determinants of one or more microbialpathogens that are each pathogenic (or commonly pathogenic or mostcommonly pathogenic) in the specific organ or tissue of the patientwithin which the cancer is situated. The following data illustrates thesurprising effectiveness of these selected formulations:

(1) The use of MRV (which contains many common respiratory tractpathogens and Staphylococcus aureus, the most common pathogen of bothbreast and bone) was found to be helpful for the treatment of breastcancer with metastases to the bone (see FIG. 6). However, survivalbenefit (survival of patients who were treated with MRV compared tothose who were not) was modest (i.e., median survival of 31 months forpatients treated with the vaccine compared to 26 months for patients nottreated with the vaccine). On the other hand, the one patient (PatientR) who was treated with a vaccine specifically targeted for breastcancer and bone cancer (i.e., containing only Staphylococcus aureus, byfar the most common cause of both breast and bone infection) had aremarkable survival benefit, surviving for more than 17 years. Theinclusion, in MRV, of other bacterial species that do not (or far lesscommonly) cause bone infection and commonly cause infection elsewhere(i.e., respiratory tract) appears to substantially reduce the benefit ofthis vaccine for the treatment of cancer of the breast and bone.(2) The survival of stage 3B lung cancer patients treated with Respivax™(i.e., median survival of 38 months and 40% 5-year survival) wassubstantially greater than the survival of stage 3B lung cancer patientstreated with MRV (i.e., median survival of 18 months and 14% 5-yearsurvival). Respivax™ contains substantially greater relativeconcentrations of the bacterial species that commonly cause lunginfection than MRV does. 67% of the bacterial cell count of Respivax™ iscomprised of bacterial species that are the common causes of lunginfection, whereas only 30% of the bacterial cell count of MRV iscomprised of bacterial species that are the common causes of lunginfection. Thus, the composition having the greater proportion ofbacteria that most commonly cause lung infections, Respivax™, is shownto be more effective for the treatment of lung cancer than the MRVformulation.(3) The survival of stage 4 colon cancer patients treated with MRV(which does not contain any colon pathogens) was poorer than patientsnot treated with a vaccine. This indicates that treatments that useantigenic determinants that are not derived from microbes that arepathogenic in the organ or tissue in which the cancer is situated maynot only be ineffective, but may also be deleterious.(4) The Murine Studies set out below, and in particular the cancer cellmodel data involving treatment with Klebsiella pneumoniae antigenicdeterminants alone, compared to treatment with Klebsiella pneumoniaeantigens in conjunction with additional antigens.The data herein accordingly provide evidence of an increasing gradationof benefit from pathogenic, to commonly pathogenic, to most commonlypathogenic for the treatment cancer within a specific organ or tissueusing targeting antigenic compositions that are derived from microbialpathogens that are pathogenic to that specific organ or tissue.

In some embodiments, the invention comprises the use of bacterial orviral vaccines that are approved for other purposes (e.g., poliomyelitisvaccine, H. influenza vaccine, meningococcal vaccine, pneumococcalvaccine, influenza vaccine, hepatitis B vaccine, hepatitis A vaccine,diphtheria vaccine, tetanus vaccine, pertussis vaccine, measles vaccine,mumps vaccine, rubella vaccine, varicella vaccine, BCG vaccine, choleravaccine, Japanese encephalitis vaccine, rabies vaccine, typhoid vaccine,yellow fever vaccine, small pox vaccine, etc.) for use as cancertreatments by selecting a vaccine containing a pathogen (or antigenicconstituent of a pathogen) that is pathogenic in the specific organ ortissue of the patient within which the cancer is situated by consultingTables 1-5. For example, a S. pneumoniae vaccine, either a whole cellvaccine or a vaccine comprised of one or more antigenic components of S.pneumoniae (e.g., pneumococcal polysaccharide-23-valent) could be usedto treat cancer at any of the following sites in which S. pneumoniae islisted as a common pathogen in Table 5: pulmonary hilar lymph nodes,hematological cancers, bone, meninges, spinal cord, eye/orbit, sinus,thyroid, bronchi, lungs, pleura or peritoneum. As a further example, ahepatitis B vaccine could be used to treat cancer at any of thefollowing sites in which hepatitis B virus is listed as a pathogen inTable 4, as follows: liver, pancreas, or hematological cancers.

In some embodiments, selected compositions and methods are specificallyexcluded from the scope of the invention. For example, the use of thefollowing microbial pathogens in the treatment of the following cancersis excluded from some embodiments, so that the claimed invention mayextend to particular embodiments with the exception of one or more ofthe following:

a) BCG (Mycobacterium bovis) for the treatment of stomach cancer andcolon cancer, for example by injection;b) Mycobacterium w for the treatment of lung cancer, for example byinjection;c) Mycobacterium vaccae for the treatment of non-small-cell lung cancer,for example by injection;d) Corynebacterium parvum for the treatment of melanoma, for example byinjection;e) Streptococcus pyogenes for the treatment of stomach cancer, forexample by injection;f) Nocardia rubra for the treatment of lung cancer or acute myelogenousleukemia, for example by injection;g) Lactobacillus casei for the treatment of cervical cancer, for exampleby injection;h) Pseudomonas aeruginosa for the treatment of lymphoma and lung cancer,for example by injection;i) Vaccinia for the treatment of melanoma, for example by injection;j) Rabies virus for the treatment of melanoma, for example by injection;k) A composition consisting of the combined antigens of the followingbacterial species for the veterinary (or, alternatively, human)treatment, for example by oral administration, for primary (or,alternatively, metastatic) cancers situated in the lung: Streptococcuspneumoniae; Neisseria catarrhalis; Streptococcus pyogenes; Haemophilusinfluenzae; Staphylococcus aureus; Klebsiella pneumoniae.l) A composition consisting of the combined antigens of the followingbacterial species for the veterinary (or, alternatively, human)treatment, for example by oral administration, for primary (or,alternatively, metastatic) cancers situated in the lung: Streptococcuspneumoniae; Neisseria catarrhalis; Streptococcus pyogenes; Haemophilusinfluenzae; Staphylococcus aureus; Klebsiella pneumoniae; Klebsiellaozaenae; Streptococcus viridans.

Example 4 Murine Studies

In the following murine studies, the following common materials

were utilized: PBS (Gibco), and mice were 7 week-old female C57BU6.

Example 4A Cancer of the Lung

This section relates to a Lewis lung carcinoma mouse model. Thebacterial vaccines used in this experiment were as follows:Streptococcus pneumoniae [cells and broth] vaccine (lot #J049-1 [2×10⁹]; Klebsiella pneumoniae [cells and broth] vaccine (lot #J046-1 [2×10⁹]; Staphylococcus aureus [cells and broth] vaccine (lot #J041-2 [10×10⁹]; Escherichia coli (colon isolate) [cells and broth] vaccine (lot#J047-1 [6×10⁹ ]; Salmonella enterica [cells and broth] vaccine (lot#J31 [15×10⁹ ]; Klebsiella pneumoniae [cells only] vaccine (lot #J048-1[2×10⁹]; and media only (Klebsiella pneumoniae media) (lot #J046-1).Mice were treated in accordance with the experimental groupings definedin Table 6.

TABLE 6 Experimental Groupings for Lung Cancer Mouse Model Lewis Lungi.v. s.c. injection dose schedule 10e5 cells/100 μl Vial Day: −10, −8,−6, −4, −2, +2, +4, Group Mice Day 0 # Vaccine +6, +8, +10, +12, +14,+16, etc. 1AB 8 | 1 S. pneumoniae [cells and broth] 200 × 10e6 CFUs/150μl/mouse 2AB 8 | 2 K. pneumoniae [cells and broth] 150 × 10e6 CFUs/75μl/mouse 3AB 8 | 3 S. aureus [cells and broth] 1 × 10e9 CFUs/100μl/mouse 4AB 8 | 4 E. coli (colon) [cells and broth] 0.9 × 10e9 CFUs/150μl/mouse 5AB 8 | 5 S. enterica [cells and broth] 1.5 × 10e9 CFUs/100μl/mouse 6AB 8 | 1 + 2 S. + K. pneumoniae [cells and S. 200 × 10e6CFUs/75 μl/mouse | broth]* K. 150 × 10e6 CFUs/75 μl/mouse 7AB 8 | 8 K.pneumoniae [cells only] 150 × 10e6 CFUs/75 μl/mouse 8ABC 12 | 9 Mediaonly (K. pneumoniae media) 75 μl/mouse ↓ (control) 9AB 8 PBS only nonenone

Specifically, groups of mice were pre-treated sub-cutaneously withbacterial vaccines on days −10, −8, −6, −4, and −2. On day 0, mice werechallenged intravenously with a dosage of 10e5 Lewis lung carcinomacells (Cedarlane lot#508714). Thereafter, the mice were treatedsub-cutaneously with vaccine injections every second day for theduration of the experiment as defined in Table 6. A control group wastreated with media only. Animal weights were measured and recorded every4 days. When mice started showing morbidity the experiment wasterminated. Thereafter, all mice were humanely sacrificed and the lungswere surgically removed and weighed. Lungs were placed into the vialswith Buoin's fluid and the numbers of lung nodules in each group werecounted. These results are illustrated in Table 7. Representativeexamples of these lungs are depicted in FIG. 14.

TABLE 7 Number of visible lung tumours in mice in each group Number ofGroup Vaccine visible lung tumours Average Median 1 S. pneumoniae 13, 1,7, 1, 20, 38, 50, 20.6 16.5 35 2 K. pneumoniae 1, 10, 0, 0, 1, 2, 50 9.11 3 S. aureus 1, 5, 3, 15, 10, 57, 43, 21.5 12.5 38 4 E. coli 4, 3, 0,9, 16, 3, 42, 40 14.6 6.5 5 S. enterica 0, 0, 2, 5, 2, 57, 52 16.8 2 6S + K. pneumoniae 1, 6, 0, 0, 8, 5, 47, 48 14.3 5.5 7 K. pneumoniae 0,3, 0, 0, 0, 1, 46, 49 12.3 0.5 (cells only) 8 Control (medium) 2, 3, 12,25, 39, 26, 31.7 26 62, 39, 78

The weights of the lungs of mice injected with tumour cells were thencompared to the weights of the lungs of mice injected with PBS only, todetermine the tumour burden and thus, the therapeutic effect of vaccinetreatment. These results are illustrated in Table 8.

TABLE 8 Average lung weight (mg) and tumour weight inhibition (comparedto control) in mice immunized with killed bacterial vaccines inintravenously implanted Lewis lung carcinoma model Av. Difference TumourLung from Weight weight healthy Inhibi- Group Vaccine (mg) mice tion (%)1 S. pneumonia (cells and broth) 495 318 30 2 K. pneumonia (cells andbroth) 298 121 73 3 S. aureus (cells and broth) 485 308 32 4 E. coli(cells and broth) 372 195 57 5 S. enterica (cells and broth) 331 154 666 S + K. pneumonia (cells 374 197 57 and broth) 7 K. pneumoniae (cellsonly) 294 117 74 8 Control (media only) 633 456 — 9 Healthy mice 177 —

Example 4B Cancer of the Skin

This section relates to a mouse model of skin cancer. The bacterialvaccines used in this experiment were as follows: Streptococcuspneumoniae [cells and broth] vaccine (lot #J049-1 [2×10⁹ ]; Klebsiellapneumoniae [cells and broth] vaccine (lot #J046-1 [2×10⁹ ];Staphylococcus aureus [cells and broth] vaccine (lot #J041-2 [10×10⁹ ];Escherichia coli (colon isolate) [cells and broth] vaccine (lot #J047-1[6×10⁹ ]; Salmonella enterica [cells and broth] vaccine (lot #J31[15×10⁹ ]; Staphylococcus aureus [cells only] vaccine (lot #J041-2[10×10⁹]; and media only (S. aureus media) (lot #J041-1). Mice weretreated in accordance with the experimental groupings defined in Table9.

TABLE 9 Experimental Groupings for Skin Cancer Mouse Model B16 melanomas.c. s.c. injection dose schedule 2 × 10e5 cells Day: −10, −8, −6, −4,−2, +2, +4, Group Mice 0.1 mL Day 0 Vaccine +6, +8, +10, +12, +14, +16,etc. AB1 8 | S. pneumoniae [cells and broth] 300 × 10e6 CFUs/150μl/mouse AB2 8 | K. pneumoniae [cells and broth] 150 × 10e6 CFUs/75μl/mouse AB3 8 | S. aureus [cells and broth] 1 × 10e9 CFUs/100 μl/mouseAB4 8 | E. coli (colon) [cells and broth] 0.9 × 10e9 CFUs/150 μl/mouseAB5 8 | S. enterica [cells and broth] 1.5 × 10e9 CFUs/100 μl/mouse AB6 8| S. aureus [cells only] 1 × 10e9 CFUs/100 μl/mouse ABC7 12 ↓ Media only(S. aureus media) (control) 100 μl/mouse

Specifically, groups of mice were pre-treated sub-cutaneously withbacterial vaccines on days −10, −8, −6, −4, and −2. On day 0, mice werechallenged intravenously with a dosage of 2×10e6 of B16 melanoma cells(lot #3995448; ATCC CRL-6323). Thereafter, the mice were treatedsub-cutaneously with vaccine injections every second day for theduration of the experiment as defined in Table 9. A control group wastreated with media only. Animal weights were measured and recorded every4 days. Once tumours were palpable, the tumour diameters were measuredevery second day using callipers. When mice started showing morbidity,or tumour diameters reached 20 mm in any group, the experiment wasterminated. Thereafter, all mice were humanely sacrificed. The averagevolumes of the tumours present in the groups of mice described hereinare illustrated in FIG. 15.

Example 4C Cancer of the Colon

This section relates to a mouse model of colon cancer. The bacterialvaccines used in this experiment were as follows: Streptococcuspneumoniae [cells and broth] vaccine (lot #J049-1 [2×10⁹ ]; Klebsiellapneumoniae [cells and broth] vaccine (lot #J046-1 [2×10⁹ ];Staphylococcus aureus [cells and broth] vaccine (lot #J041-2 [10×10⁹ ];Escherichia coli (colon isolate) [cells and broth] vaccine (lot #J047-1[6×10⁹ ]; Escherichia coli (prostate isolate) [cells and broth] vaccine(lot #J040-2 [6×10⁹ ]; Salmonella enterica [cells and broth] vaccine(lot #J31 [15×10⁹]; and media only (E. coli media) (lot #J040-1). Micewere treated in accordance with the experimental groupings defined inTable 10.

TABLE 10 Experimental Groupings for Colon Cancer Mouse Model MC-38 coloni.p. s.c. injection dose schedule 2 × 10e5 Day: −10, −8, −6, −4, −2, +2,+4, Group Mice Day 0 Vaccine +6, +8, +10, +12, +14, +16, etc. 1AB 8 | S.pneumoniae [cells and broth] 300 × 10e6 CFUs/150 μl/mouse 2AB 8 | K.pneumoniae [cells and broth] 150 × 10e6 CFUs/75 μl/mouse 3AB 8 | S.aureus [cells and broth] 1 × 10e9 CFUs/100 μl/mouse 4AB 8 | E. coli(colon) [cells and broth] 0.9 × 10e9 CFUs/150 μl/mouse 5AB 8 | E. coli(prostate) [cells and broth] 0.9 × 10e9 CFUs/150 μl/mouse 6AB 8 | S.enterica [cells and broth] 1.5 × 10e9 CFUs/100 μl/mouse 7ABC 12 ↓ Mediaonly (E. coli media) (control) 150 μl/mouse

Specifically, groups of mice were pre-treated sub-cutaneously withbacterial vaccines on days −10, −8, −6, −4, and −2. On day 0, mice werechallenged intraperitoneally with a dosage of 2×10e5 MC-38 colloadenocarcinoma cells (gift from Dr. Jeff Schlom Lab, NCI). Thereafter,the mice were treated sub-cutaneously with vaccine injections everysecond day for the duration of the experiment as defined in Table 10. Acontrol group was treated with media only. The mice were observed forthe following clinical factors: weight, cold to touch, diarrhea, rapidrespiration, closed eyes, decreased movement, piloerection, andconvulsions. When a mouse started to show signs of clinical morbidity,the mouse was humanely sacrificed and that day was defined as the day ofdeath. Survival data for this Example is depicted in FIG. 16.

Further, the health versus morbidity/mortality of the mice involved inthis Example was calculated on day 29 of the experiment as defined inTable 11.

TABLE 11 Health v. Morbidity/Mortality Group Score** Group Group HealthStatus Day 29 Vaccine Score 1 7 dead; 1 tumour + ascites S. pneumoniae 22 5 dead; 1 tumour + ascites; K. pneumoniae 17 1 tumour only; 1 healthy3 4 dead; 2 tumour + ascites; S. aureus 14 2 tumour only 4 3 dead; 3tumour only; E. coli (colon 35 2 healthy infection isolate) 5 3 dead; 3tumour only; E. coli (prostate 35 2 healthy infection isolate) 6 3 dead;5 healthy S. enterica 50 7 12 dead Control (media only) 0 **healthy = 10points; tumour only = 5 points; tumour + ascites = 2 points; and dead =0 points.

TABLE 12 Summary of survival for each mouse group from colon cancerexperiments Mice/ MST* ILS** # P Vaccine group (Days) (%) Cured value***S. pneumoniae 8 27 12 0 0.29 K. pneumoniae 8 36 50 3 0.061 S. aureus 830 25 2 0.002 E. coli (colon) 8 35 46 3 0.008 E. coli (prostate)8 >78 >100 4 0.001 S. enterica 8 >78 >100 5 0.003 Control 12 24 0 0 —*MST—Median survival time **ILS—Increase in life span over control group***comparison to placebo treated control group Overall ComparisonSurvival: Log Rank (Mantel Cox) p = 0.001 Breslow (Generalized Wilcoxon)p = 0.003 Tarone-Ware p = 0.002

Example 4 Summary Skin Model:

There is a marked therapeutic advantage for the group treated with Staphaureus (cells-only). This study demonstrates the effectiveness of akilled S. aureus vaccine for the treatment of skin cancer in a mousemodel, consistent with the fact that S. aureus is the most common causeof skin infection in mice. The data are consistent with the use ofimmungenic compositions of the invention to slow or inhibit cancergrowth. The S. aureus cells-only vaccine (in which media and exotoxinswere removed by centrifuging the cells and broth to collect only thecells and then reconstituting with normal saline) was more effectivethan S. aureus cells and broth vaccine (which contains media andexotoxins). This may be because S. aureus extoxins inhibit immunefunction, such as leuocidins that can kill white blood cells. Theinvention accordingly includes embodiments in which antigenicdeterminants that are to be used in immunogenic compositions areseparated from immunomodulatory compounds produced by a microbialpathogen of interest.

Lung Model:

The data presented in this Example indicate that there was substantialtumour inhibition with the immunogenic composition derived from K.pneumoniae, consistent with the fact that K. pnuemoniae is a commoncause of lung infection in mice. In mice (but generally not in humans),S. enterica can cause pneumonia, which is consistent with the beneficialeffect of this vaccine in the mouse lung model. Unlike humans, for whomS. pneumoniae is a common lung pathogen, S. pneumoniae is relativelyrarely a lung pathogen in mice (although S. pneumoniae pneumonia can beinduced in mice). E. coli and S. aureus can uncommonly cause lunginfection in mice, which is consistent with their mild benefitillustrated herein. This Example demonstrates that killed K. pneumoniaevaccine is remarkablly effective for the treatment of cancer of thelungs in mice, particularly embodiments in which the immunogeniccomposition includes antigens of only the most commonly pathogenicorganism (see Group 2 vs. Group 6).

Colon Model:

S. enterica is one of the most common causes of gastrointestinal andintraperitoneal infection in mice, which is consistent with thebeneficial effect illustrated herein in the treatment ofgastrointestinal and intraperitonal cancer in mice.

Of the immunogenic compositions used in this Example (i.e., S. enterica,E. coli, S. aureus, K. pneumoniae, S. pneumoniae), S. enterica is themost common g.i./abdominal pathogen in mice. E. coli is the next mostcommon g.i./abdominal pathogen in mice. S. aureus and K. pneumoniae canbe found as part of the colonic flora and can cause g.i./abdominalinfection, although far less commonly. S. pneumoniae does not causeg.i./abdominal infection. In accordance with this, the S. entericavaccine is shown to be substantially benefical in this mouse colontumour model, E. coli vaccine is shown to be moderately beneficial, S.aureus and K. pneumoniae vaccines are shown to be mildly beneficial andS. pneumoniae vaccine is shown to be of no benefit. In humans,Salmonella species cause g.i. infection and therefore, one would expectS. enterica and other Salmonella vaccines to be helpful for thetreatment of colon cancer in humans.

Example 5 Animal Models Example 5A Illustrating the Influence of a HeatInactivated Klebsiella pneumoniae Antigenic Composition onMonocyte/Macrophage and Dendritic Cell Populations in Mice

The following methods and materials were utilized in this Example:

Mice.

C57BL/6 female mice 7-8 weeks of age were ordered from Harlan Labs(Livermore, Calif.) for these studies.

Antibodies and Reagents.

The following antibodies were used in this Example: anti-I-A/I-E FITC(MHC Class II; M5/114.15.2); anti-Gr-1 PE (RB6-8C5); anti-CD11bPerCP-Cy5 (M1/70); anti-CD11c APC (N418); anti-CD4 FITC (GK1.5);anti-NK1.1 PE (PK136); anti-CD8a eFluor780 (53-6.7); anti-CD44 APC(IM7). All antibodies were acquired from eBioscience (San Diego,Calif.). Liberase TM and DNAse I was acquired from Roche. All media wasfrom HyClone (Fisher).

Treatment with Antigenic Compositions.

Heat killed K. pneumoniae with phenol (KO12 [5.0 OD600 units]) wasdiluted 1/10 in PBS containing 0.4% phenol and 100 μl was injectedsubcutaneously on day 0, 2, 4, and 6 into 4 mice. Control mice (n=5)were injected on day 0, 2, 4, and 6 with PBS.

Brochoalveolar Lavage.

On day 7 mice were sacrificed and a bronchoalveolar lavage (BAL) wasperformed by exposing the trachea followed by insertion of a 22Gcatheter attached to a 1 ml syringe. 1 ml of PBS was injected into thelungs and removed and placed into a 1.5 ml microcentrifuge tube. Thelungs were subsequently washed 3 more times with 1 ml of PBS and thefluid was pooled. The first wash from each mouse was centrifuged at400×g and the supernatant was frozen for cytokine analysis. The final 3ml of lavage fluid was centrifuged and the cells were pooled with thecell pellet from the first lavage. The cells were counted and stainedwith antibodies specific for MHC class II, Ly6G/C, CD11b, and CD11c.After staining the cells were washed and analyzed on a FACS Calibur flowcytometer.

Lung Digestion.

After BAL was performed the lungs were placed in 5 ml of RPMI containing417.5 μg/ml Liberase TL (Roche) and 200 μg/ml DNAse I (Roche). The lungswere then digested at 37° C. for 30 mins. After digestion the lungs wereforced through a 70 um cell strainer to create a single cell suspension.The cells were then centrifuged, washed, resuspended in FACS Buffer (PBSwith 2% FCS and 5 mM EDTA) and counted. After counting the cells werestained and analyzed by FACS using the same antibodies as for the BALcells.

Peritoneal Lavage.

1 ml of PBS was injected into the peritoneum of mice using a 1 mlsyringe attached to a 25G needle after BAL. The abdomen was massaged for1 minute and 0.5 ml of PBS was recovered from the peritoneum using a 1ml pipet. The lavage fluid was put in a 1.5 ml centrifuge tube,centrifuged at 400×g for 5 mins, and resuspended in FACS buffer prior tostaining and FACS analysis.

Spleen and Lymph Node Analysis.

The spleen and draining lymph node were removed after BAL and peritoneallavage and placed in PBS. The spleen was disrupted by mashing through a70 μm cell strainer (Fisher) and the lymph node was disrupted using therubber end of the plunger from a 1 ml syringe. After disruption, thesingle cell suspension from the spleen and lymph nodes was centrifuged,washed once with FACS Buffer, and resuspended in FACS Buffer prior tocounting, staining, and FACS analysis.

FAGS Analysis.

Cells were stained on ice for 20 mins in 96 well plates using 50 ul ofantibodies diluted in FACS buffer. After 20 mins, 100 μl of FACs bufferwas added to the wells and the plates were centrifuged at 400×g for 5mins. Subsequently the media was removed and the cells were washed 1more time with FACS buffer. After the final wash the cells wereresuspended in 200 μl of FACS buffer and the data was acquired using aFACS Calibur flow cytometer (BD). A minimum of 20,000 live events werecollected for all samples except the BAL where a minimum of 5,000 eventswas collected.

The following results were obtained in this Example.

Normal mice without tumours were treated with a K. pneumoniae antigeniccomposition on day 0, 2, 4, and 6. On day 7 the mice were sacrificed andthe bronchoalveolar lavage fluid, lung tissue, peritoneal lavage fluid,lymph nodes, and spleen was analyzed for changes in monocyte andmacrophages. An increase in the number of acute inflammatory bloodmonocytes/macrophages, defined by high expression of CD11b and Gr-1(same marker as Ly6c), and F4/80 in the lymph node draining the site ofinjection of the K. pneumoniae antigenic composition was observed (see:FIG. 17A). These acute inflammatory monocytes/macrophages also expressvery high levels of MHC class II molecules suggesting exposure tobacterial antigens. Importantly, treatment of mice with the K.pneumoniae antigenic composition for one week led to a marked increasein the frequency of acute inflammatory monocytes in the bronchoalveolarlavage fluid and in the lungs (i.e., the targeted organ) but not in thespleen or peritoneum of treated mice, suggesting that treatment caninduce homing of monocytes specifically to the lungs without affectingother organs (see: FIG. 17B). Monocytes can differentiate into dendriticcells (DCs) in the lungs (35) and consistent with our observations of amarked increase in monocyte recruitment it was also observed that therewas a marked increase in the frequency of cells displaying markers formature DCs (see: FIG. 17C).

As illustrated in FIG. 17, treatment with a K. pneumoniae antigeniccomposition for 7 days resulted in a marked increase (compared totreatment with placebo=PBS) in both acute inflammatory monocytes anddendritic cells in the lungs of mice. As illustrated in FIG. 17, micewere treated with either a K. pneumoniae antigenic composition for orPBS on day 0, 2, 4, and 6. On day 7, the mice were sacrificed and thetotal number of A) and B) inflammatory monocytes (CD11b+ Gr-1+ cells)and C) dendritic cells (CD11c+ MHC class II+ cells) were determined byflow cytometry in the lung and spleen. The error bars depicted in A)represent the mean of 4-5 mice per group.

Example 5B Illustrating the Influence of a Heat Inactivated Klebsiellapneumoniae Antigenic Composition and a Heat Inactivated E. coliAntigenic Composition on Monocyte/Macrophage, Dendritic Cell, andEffector Cell Populations in Mice

The following methods and materials were utilized in this Example:

Mice.

C57BL/6 female mice 7-8 weeks of age were ordered from Harlan Labs(Livermore, Calif.) for these studies.

Antibodies and Reagents.

The following antibodies were used: anti-I-A/I-E FITC (MHC Class II;M5/114.15.2); anti-Gr-1 PE (RB6-8C5); anti-CD11b PerCP-Cy5 (M1/70);anti-CD11c APC(N418); anti-CD4 FITC (GK1.5); anti-NK1.1 PE (PK136);anti-CD8a eFluor780 (53-6.7); anti-CD44 APC (IM7). All antibodies wereacquired from eBioscience (San Diego, Calif.). Liberase TM and DNAse Iwas acquired from Roche. All media was from HyClone (Fisher).

Treatment with Antigenic Compositions.

Heat-killed K. pneumoniae with phenol (K. pneumoniae; lot KO12; 5.0OD600 units) was diluted 1/10 in PBS containing 0.4% phenol and 100 ulwas injected subcutaneously on day 0, 2, 4, and 6 into 5 mice.Heat-killed E. coli (lot; 5.0 OD600 units) was diluted 1/10 incontaining 0.4% phenol and 100 μl was injected subcutaneously on day 0,2, 4, and 6 into 5 mice. Control mice (n=5) were injected on day 0, 2,4, and 6 with PBS.

Brochoalveolar Lavage.

On day 7 mice were sacrificed and a bronchoalveolar lavage (BAL) wasperformed by exposing the trachea followed by insertion of a 22Gcatheter attached to a 1 ml syringe. 1 ml of PBS was injected into thelungs and removed and placed into a 1.5 ml microcentrifuge tube. Thelungs were subsequently washed 3 more times with 1 ml of PBS and thefluid was pooled. The first wash from each mouse was centrifuged at400×g and the supernatant was frozen for cytokine analysis. The final 3ml of lavage fluid was centrifuged and the cells were pooled with thecell pellet from the first lavage. The cells were counted and stainedwith antibodies specific for MHC class II, Ly6G/C, CD11b, and CD11c.After staining the cells were washed and analyzed on a FACS Calibur flowcytometer.

Lung Digestion.

After BAL was performed the lungs were placed in 5 ml of RPMI containing417.5 μg/ml Liberase TL (Roche) and 200 μg/ml DNAse I (Roche). The lungswere then digested at 37° C. for 30 mins. After digestion the lungs wereforced through a 70 μm cell strainer to create a single cell suspension.The cells were then centrifuged, washed, resuspended in FACS Buffer (PBSwith 2% FCS and 5 mM EDTA) and counted. After counting the cells werestained and analyzed by FACS using the same antibodies as for the BALcells.

Peritoneal Lavage.

1 ml of PBS was injected into the peritoneum of mice using a 1 mlsyringe attached to a 25G needle after BAL. The abdomen was massaged for1 minute and 0.5 ml of PBS was recovered from the peritoneum using a 1ml pipet. The lavage fluid was put in a 1.5 ml centrifuge tube,centrifuged at 400×g for 5 mins, and resuspended in FACS buffer prior tostaining and FACS analysis.

Spleen and Lymph Node Analysis.

The spleen and draining lymph node were removed after BAL and peritoneallavage and placed in PBS. The spleen was disrupted by mashing through a70 μm cell strainer (Fisher) and the lymph node was disrupted using therubber end of the plunger from a 1 ml syringe. After disruption, thesingle cell suspension from the spleen and lymph nodes was centrifuged,washed once with FACS Buffer, and resuspended in FACS Buffer prior tocounting, staining, and FACS analysis.

FAGS Analysis.

Cells were stained on ice for 20 mins in 96 well plates using 50 μl ofantibodies diluted in FACS buffer. After 20 mins, 100 μl of FACs bufferwas added to the wells and the plates were centrifuged at 400×g for 5mins. Subsequently the media was removed and the cells were washed 1more time with FACS buffer. After the final wash the cells wereresuspended in 200 μl of FACS buffer and the data was acquired using aFACS Calibur flow cytometer (BD). A minimum of 20,000 live events werecollected for all samples except the BAL where a minimum of 5,000 eventswas collected.

The following results were obtained in this Example:

As illustrated in FIG. 18, mice were treated on day 0, 2, 4, and 6 witheither a K. pneumoniae antigenic composition, an E. coli antigeniccomposition or PBS. On day 7 the mice were sacrificed and the totalnumber of inflammatory monocytes (CD11b+Gr-1+ cells) and dendritic cells(CD11c+MHC class II+ cells) were determined by flow cytometry in theperitoneal lavage fluid, lungs, lymph node and spleen. Error bars inFIG. 18 represent the standard deviation from 5 mice. *p-value <0.05using a Student's t-test.

FIG. 18 illustrates that treatment with a K. pneumoniae antigeniccomposition, but not an E. coli antigenic composition treatment,markedly increased the number of monocytes and DCs in the lungs of mice.In contrast to the lungs, K. pneumoniae did not lead to an increase inmonocytes in the peritoneum of the mice whereas E. coli did.Importantly, there was only a slight increase in the number ofinflammatory monocytes and no increase in DCs in the spleens of micetreated with either K. pneumoniae or E. coli suggesting that the effectsof the therapie are not general and are, in fact, specific for aparticular organ site. In addition to looking at the effects oftreatment on inflammatory monocytes and DCs in the lungs of mice, wealso looked at changes in other leukocytes such as cytotoxic CD8 Tcells, CD4 T helper cells, and natural killer (NK) cells all of whichcan potentially play a role in anti-tumour immunity.

FIG. 19 illustrates that a K. pneumoniae antigenic composition, but notPBS or an E. coli antigenic composition, resulted in a marked increasein the frequency and total numbers of NK cells, CD4 and CD8 T cells inthe lungs of treated mice. This Example is the first demonstration toour knowledge that subcutaneous injection of a killed bacterial specieswhich normally causes lung infection can promote the accumulation ofleukocytes in the lungs without the presence of any inflammation in thatsite. In addition, we have demonstrated that this effect is specific tothe targeted site and that it is also specific to the bacterialconstituents of the treatment used.

As illustrated in FIG. 19, mice were treated on day 0, 2, 4, and 6 witheither a K. pneumoniae antigenic composition, an E. coli antigeniccomposition, or PBS. On day 7, the mice were sacrificed and the totalnumber of CD4 T cells, CD8 T cells, and natural killer (NK) cells weredetermined by flow cytometry. Error bars represent the sd of valuesobtained from 5 mice per group. *p-value <0.05 using a Student's t-test.

Example 5C Illustrating the Effects of Heat and Phenol InactivatedKlebsiella pneumoniae (K. pneumoniae) Antigenic Compositions onAnti-Tumor Response in Mice, and the Status of Inflammatory Monocytesand Dendritic Cells Following Treatment in Tumor-Bearing Mice

The following methods and materials were utilized in this Example:

Tumour Cell Inoculations.

The Lewis lung carcinoma cell line derived from the C57BU6 backgroundwere acquired from ATCC (Manassas, Va.). The cells were maintained inDulbecco's Modified Eagles Media (ATCC, Manassas, Va.) containing 10%FCS. The cells were grown in a humidified 37° C. incubator with 5% CO₂.Prior to tumour inoculation, cells were detached from culture platesusing 0.25% trypsin and 0.53 mM EDTA. The cells were washed in PBS andresuspended at 8×10⁶ cells/ml and 200 ul (4×10⁵ cells) was injectedintravenously into mice.

Treatment with Antigenic Composition.

The following antigenic compositions were used in this study: aheat-inactivated K. pneumoniae antigenic composition with phenol (lotKO12) and a phenol-inactivated K. pneumoniae antigenic composition (lotKO25). Both heat-inactivated K. pneumoniae and phenol-inactivated K.pneumoniae are concentrated to 5.0 OD600 units. 0.1 ml of K. pneumoniaediluted 1/10 in PBS with 0.4% phenol was injected subcutaneously every 2days starting on day 2 after tumour injection.

Analysis of Inflammatory Monocytes, DCs, T Cells, and NK Cells.

All analysis was done according to the methods used in Example 5B above.

TABLE 13 Experimental groupings and dose schedule for Example 5C LL/2Tumor Site of Concentration of cells LL/2 K. Pneumoniae ScheduleInjection Number of and Tumor (OD units) of Volume Date of Groupanimals/sex dose Injection Treatment Injections Treatment (ml) Sacrifice1A 5F 4 × 10⁵ Intravenous DPBSWP¹ None Once daily 0.1 Day 9 2A 5F LL/2HKWP² 0.05 on day 2, 3A 5F PHWP³ 0.05 4, 6, and 8 1B 5F DPBSWP¹ NoneOnce daily Day 16 2B 5F HKWP² 0.05 on day 2, 3B 5F PHWP³ 0.05 4, 6, 8,10, 12, 14, 1C 5F DPBSNP¹ None Once daily Day 23 2C 5F HKWP² 0.05 on day2, 3C 5F PHWP³ 0.05 4, 6, 8, 10, 12, 14, 16, 18, 20, 22 ¹Dulbecco'sPhosphate Buffered Saline with phenol ²Heat killed with phenol ³Phenolkilled with phenol

The following results were obtained in this Example:

This example was designed to determine if the presence of tumourimpacted the recruitment of cells to the lungs and whether the treatmenteffect increases over time resulting in further increases in cellrecruitment with ongoing treatment and thus, potentially, more optimaltherapeutic effect with prolonged treatment. In addition, we wanted todetermine whether a K. pneumoniae antigenic composition inactivated byphenol was more effective than a K. pneumoniae antigenic compositioninactivated by heat.

FIG. 20 clearly demonstrates that by day 9 (i.e., 4 treatments with a K.pneumoniae antigenic composition) there is already a marked increase inthe number of acute inflammatory monocytes, DCs, T cells, and NK cellsin the lungs of mice treated with a K. pneumoniae antigenic compositioninactivated by heat or phenol, many times greater than that of the lungsof mice treated with placebo (normal saline=PBS), again, clearlydemonstrating the marked targeted cellular immune response in the lungstriggered by K. pneumoniae antigenic composition therapy. On day 9,there was a suggestion that phenol inactivation was more effective thanheat inactivation, but this trend reversed by day 16. Importantly,however, with reference to the cell numbers in the lungs on day 9 andday 16, it is evident that there is a cumulative effect of bacterialtreatment on the recruitment of cells to the lungs. For example in thegroup treated with a phenol inactivated K. pneumoniae antigeniccomposition there are about 100,000 acute inflammatory monocytes in thelungs of the mice at day 9 and this number increases substantially to400,000 by day 16, demonstrating a substantially increasing responsewith ongoing treatment. The same increased treatment response withongoing treatment occurred in mice treated with heat inactivatedbacteria. Importantly, this cumulative treatment effect is observed forall other cell types analyzed as well. In this study, there was nodemonstrable statistically significant difference in immune cellrecruitment with heat or phenol inactivated K. pneumoniae antigeniccompositoins.

As illustrated in FIG. 20, mice were injected with 4×10⁵ lewis lungcarcinoma cells intravenously on day 0. The mice were subsequentlytreated every other day starting on day 2 with a K. pneumoniae antigeniccomposition generated by heat inactivation, or phenol inactivation, orwith PBS. On day 9 and day 16 the mice were sacrificed and the totalnumbers of (A) inflammatory monocytes (CD11b+ Gr-1+) and DCs (CD11c+lab+) or (B) CD4 T cells, CD8 T cells, and natural killer (NK) cellswere determined by flow cytometry. Bars represent respectively: the PBStreated group, the mice treated with a heat-inactivated K. pneumoniaeantigenic composition and mice treated with a phenol-inactivated K.pneumoniae antigenic composition. Error bars represent the sd of valuesobtained from 5 mice per group. *p-value <0.05 using a Student's t-test.

The results of this study demonstrate an increasing immune responsewithin the targeted tissue with ongoing treatment.

Example 5D Illustrating the Effects of Heat, Irradiation, and PhenolInactivation on K. pneumoniae Antigenic Compositions, IncludingLeukocyte Recruitment into the Lungs of Mice, and the Effects of Phenolas a Preservative has any Effects

The following methods and materials were utilized in this Example:

Mice.

C57BL/6 female mice 7-8 weeks of age were ordered from Harlan Labs(Livermore, Calif.) for these studies.

Antigenic Compositions.

Heat killed K. pneumoniae antigenic composition with phenol (KO12), heatkilled K. pneumoniae antigenic composition without phenol (KO25),irradiated K. pneumoniae antigenic composition without phenol (KO24),and phenol killed K. pneumoniae antigenic composition without phenol(KO25) were used in this study. All bacterial formulations were at aconcentration of 5.0 OD units in saline. For 1/10 dilution, 1 ml ofbacterial formulation was added to 9 ml of DPBS and mixed immediatelyand then again prior to injection. For 1/100 dilution, 0.1 ml ofbacterial formulation will be added to 9.9 ml of DPBS and mixedimmediately and then again prior to injection. For dilutions ofheat-killed Klebsiella pneumoniae antigenic composition with phenol, thedilutions were carried out as above using a DPBS solution containing0.4% phenol (w/v). To prepare the 0.4% phenol in DPBS, first a 5% phenolsolution was prepared by adding 0.5 g of solid phenol (Sigma Aldrich,St. Louis, Mo.) to 10 ml of DPBS (Hyclone, Logan, Utah) This solutionwas filtered through a 0.22 um filter (Millipore, Billerica, Mass.) andstored at 4° C. Immediately prior to use the 5% phenol solution wasdiluted 1 ml in 12.5 ml DPBS and used to prepare the bacterialformulations.

Treatment with Antigenic Compositions.

5 mice per group were treated subcutaneously on day 0, 2, 4, and 6 with0.1 ml of a heat-killed K. pneumoniae antigenic composition diluted 1/10in PBS or PBS with 0.4% phenol, 0.1 ml of an irradiated K. pneumoniaeantigenic composition diluted 1/10 in PBS, or a phenol inactivated K.pneumoniae antigenic composition diluted 1/10 with PBS or PBS with 0.4%phenol. On day 7 the mice were sacrificed and leukocyte recruitment tothe lungs was analyzed as in Example 5B.

The following results were obtained in this Example:

In this example, we used leukocyte recruitment to the lungs as asurrogate of efficacy to compare the efficacy of K. pneumoniae antigeniccompositions inactivated by various methods. FIG. 21 illustrates that,for both heat killed and phenol killed K. pneumoniae antigeniccompositions, the addition of phenol (0.4%) as a preservative, increasedefficacy, as measured by cellular recruitment. In some embodiments, asmall amount of phenol (i.e., 0.4% as a preservative) may stabilize acomponent of the bacterial cell wall, for example a component that isimportant in antigen pattern recognition and activating an optimaltargeted response. In comparing the 3 formulations containing phenol asa preservative (i.e., heat killed, phenol killed and radiation killed),irradiated K. pneumoniae antigenic composition led to the greatestrecruitment of acute inflammatory monocytes, DCs, NK cells, and T cellsto the lungs, followed by phenol killed K. pneumoniae antigeniccomposition, with heat killed K. pneumoniae antigenic compositionresulting in the least cellular recruitment.

As illustrated in FIG. 21, mice were treated on day 0, 2, 4, and 6 withK. pneumoniae antigenic composition inactivated by heat (HKWP) orwithout (HKnp) phenol preservative, inactivated with phenol with (PKWP)or without (PKnp) phenol preservative, or K. pneumoniae antigeniccomposition inactivated by irradiation with phenol preservative (IRWP).On day 7 the mice were sacrificed and the total numbers of (A)inflammatory monocytes (CD11b+ Gr-1+) and DCs (CD11c+ lab+) or (B) CD4 Tcells, CD8 T cells, and natural killer (NK) cells were determined byflow cytometry. Error bars represent the sd of values from 5 mice pergroup. *p-value <0.05 compared to mice treated with IRWP using aStudent's t-test.

Example 6 Clinical Studies Involving Advanced Epithelial CancersOverview of Treatment

The following patients with different advanced cancers have undergonetreatment with heat inactivated targeted bacterial antigeniccompositions. Fully informed written consent was received for eachpatient and in every case. The treatment consisted of repeated (3×/week)subcutaneous injections of exact amounts of the vaccine in the abdominalregion. The dosage was gradually increased in each patient to achieve asufficient skin response (3-5 cm redness lasting for ca. 24 h). For eachpatient a case report form (CRF) documented skin reaction and possibleclinical effects and/or side effects related to the treatment.Characteristic and concomitant treatments as well as the response totherapy of the patients are briefly described.

Patient #1:

53 y old male patient with advanced melanoma, ICD10: C43, 1st diagnosed11/2005 lesion under right big toe nail, histology one year later12/2006: advanced malignant melanoma; patient refused amputation of thebig toe; 5/2008 lymphatic metastasis to the right leg, at the time offirst presentation for targeted bacterial antigenic compositiontreatment (9/2008) leg swollen with 100% increase in circumference:Karnofsky 80%, no pretreatment.

Treatments over 6 month 09/2008-04/2009:

-   -   12× intraperitoneal Ozone (O3) insufflation;    -   42× locoregional radiofrequency hyperthermia (13.56 Mhz);    -   18× moderate whole body hyperthermia 38.5° C.;    -   6 month treatment with Staph. aureus antigenic composition s.c.;    -   Orthomolecular medicine: high dose vitamin C infusions (0.5        g/kg/BW), Vitamin D3; 2.000 iu/day, Artesunate 200 mg/day,        Celebrex 100 mg/day, low dose naltrexone, medical; mushroom        (cordyceps, reishi, shitake), selenium 200 uc/day, curcumin        3.000 mg/day, proteolytic enzymes (Wobemugos)

Epicrisis details:

-   -   PET 7/2008: SUV in right big toe 4.81, knee: 5.01    -   PET 12/2008: SUV in right big toe 3.80, knee: 4.02    -   We started treatment end of 9/2008.    -   At that time (9/2008) there were clinically already lymph nodes        in the groin palpable which were not seen on the PET from        7/2008.    -   05/2010: good clinical condition, PET confirms complete        remission, Karnofsky 100%.

Patient #2:

48 y old female patient with advanced bilateral breast cancer, ICD10:C50.9 1st diagnosed 4/2008; histology ductal infiltrating adenocarcinomaof the breast, ER/PR pos., Her2 not known, T1/T2, N1 (sentinel nodeaxilla), M0 G3; multiple treatments with sodium bicarbonate injectionsand repeated surgery to both breasts; patient refused the proposedbilateral mastectomy and was never resected “in sano” (e.g., margins ofthe lumpectomies were never free of tumor cells). Patient also refusedChemotherapy and/or hormone therapy. Karnofsky 90%, no pretreatment.

Treatments over 8 month 03/2009-11/2009:

-   -   3× autologous Dendritic cell therapy in combination with:    -   3× long-duration moderate whole body hyperthermia 40° over 8 h    -   57× locoregional radiofrequency hyperthermia to both breasts        (13.56 Mhz)    -   6 month treatment with Staph. aureus antigenic composition s.c.    -   Orthomolecular medicine: high dose vitamin C infusions (0.5        g/kg/BW), low dose naltrexone, medical mushroom (cordyceps,        reishi, shitake), curcuma 3.000 mg/day, zinc

Epicrisis details:

-   -   Treatment started end of 3/2009.    -   05/2010: bilateral breast MRI shows no abnormality detected,        good clinical condition, Karnofsky 100%

Patient #3:

73 y old female patient with advanced NSCLC cancer FIGO IIc, ICD10: C34,1st diagnosed 6/2009; histology clear cell adenocarcinoma of the lungs,T4, N1, M0 G3; she underwent neoadjuvant CHT; the restaging after 3cycles neoadjuvant CHT demonstrated T2 tumor; she then underwent leftpneumectomy R0 resection and mediastinal lymphadenectomy; Karnofsky 90%.

Treatments over 7 month 08/2009-03/2010:

-   -   08/2009 Began chemotherapy with Taxan/Cisplatin until 10/2009 in        combination with:    -   4× long-duration moderate whole body hyperthermia 40° over 8 h        (1-2/2009)    -   20× locoregional radiofrequency hyperthermia to the thorax        (13.56 Mhz) (8-10/2009)    -   10/2009 le Pneumectomy R0 resection (Oncology decided against        further adjuvant CHT)    -   6 month treatment with Klebsiella pneumoniae antigenic        composition s.c. (08/2009-02/2010)    -   Orthomolecular medicine: thymus peptides i.m., indometacin,        cimetidine, high dose vitamin C infusions (0.5 g/kg/BW), ALA/N        protocol (low dose naltrexone and alpha lipoic acid), medical        mushroom (reishi), curcuma 3.000 mg/day, zinc, melatonin,        inhalation of ionized oxygen

Epicrisis details:

-   -   Started treatment end of 08/2009.    -   05/2010: CT Thorax and Tumor marker CEA, NSE and CYFRA show        complete remission, good clinical condition, Karnofsky 100%.

Patient #4:

50 y old female patient with advanced Breast cancer, ICD10: C50, withdisseminated hepatic and pulmonary metastasis, 1st diagnosed 8/1990;histology undifferentiated cirrhoses type adenocarcinoma of the breast,pT1c, N1, M0 G3; she underwent multiple chemotherapy courses over 20years; 11/2004 first scar reoccurrence, 12/2004 ablation left breast,6×CHT Epitax and radiation of thoracic wall; 9/2005 1st diagnosis ofdisseminated liver and pulmonary metastases: again 8×CHT with Epitaxuntil 3/2006. Restaging showed progressive disease at which time shebegan targeted bacterial antigenic composition treatment. Karnofsky 90%.

Treatments over 4 years 03/2006-03/2010:

-   -   03/2006 Began treatment with Polyvaccinum forte vaccine in        combination with:    -   3× autologous Dendritic cell therapy in combination with        (6-8/2006):    -   3× long-duration moderate whole body hyperthermia (LD-WBH) 40°        over 8 h (1-2/2009)    -   25× locoregional radiofrequency hyperthermia to the thorax &        liver (13.56 Mhz) (3-6/2006)    -   8 month treatment with Klebsiella pneumoniae antigenic        composition (11/2008-7/2009)    -   10/2009 TM CEA and CA15/3 started rising again    -   02-03/2009 2× autologous Dendritic cell therapy without LD-WBH    -   04/2010 thermal ablation of liver mets (No change of lung        metastasis)    -   Orthomolecular medicine: thymus peptides i.m., indometacin,        cimetidine, high dose vitamin C infusions (0.5 g/kg/BW), curcuma        3.000 mg/day, zinc, proteolytic enzymes

Epicrisis details:

-   -   We started treatment end of 03/2006.    -   05/2010: CT Thorax show stable disease over 4 years, progressive        disease of liver mets, good clinical condition, Karnofsky 100%.

Patient #5:

66 y old male patient with advanced prostate cancer, ICD10: C61, withdisseminated bone and lymphatic metastasis, 1st diagnosed 01/1997;histology undifferentiated adenocarcinoma of the prostate, pT3, N1, M1G3; he underwent multiple Hormone- and CHT over 13 years; patient is ingood clinical condition surviving metastatic prostate cancer for 13years since diagnosis; Karnofsky 90%.

Treatments over 11 years 11/1999-05/2010:

-   -   13 years anti-androgen with Suprefact, Zoladex, Casodex,        Trenantone, Estracyt, β-Sitosterol    -   06/2006-12/2007 Began Mixed bacterial vaccine treatment with        Polyvaccinum forte vaccine    -   Since 03/2008 regular chemotherapy with Taxotere 140 mg every        3-4 weeks    -   50× moderate whole body hyperthermia 39° over 3 h (1999-2009)    -   18 month treatment with Staph. aureus antigenic composition        (11/2008-05/2010, ongoing)    -   05-06/2009 2× autologous Dendritic cell therapy without moderate        WBH 39°, 3 h    -   Orthomolecular medicine: wheat grass, cimetidine, Zometa, high        dose vitamin C infusions (0.5 g/kg/BW), curcuma 3.000 mg/day,        boswellia serrata (Indian) 400 mg 4×4/day, zinc, proteolytic        enzymes

Epicrisis details:

-   -   We started treatment end of 1999.    -   05/2010: Bone scan shows stable disease; PSA currently 89 ng/ml,        good clinical condition, Karnofsky 90%.

Patient #6:

52 y old female patient with advanced primary cancer of the peritoneum,ICD10: C48.2, with disseminated peritoneal carcinosis, 1st diagnosed06/2003; histology undifferentiated adenocarcinoma of the peritoneum,pT3, N1, M1 G3; she underwent Debulking OP with ovarectomy bilaterly andhysterectomy and adjuvant chemotherapy with Taxol/Paraplatin:progressive disease and change to Taxol/Paraplatin with SD until 8/2008;progressive disease with disseminated peritoneal LK metastasis and 3rdline CHT with Carboplatin and beginning of treatment with targetedbacterial antigenic composition; patient was in good clinical condition;Karnofsky 100%.

Treatments over 4 month 05-09/2009:

-   -   5× Carboplatin chemotherapy (3rd line) followed by:    -   5× long-duration moderate whole body hyperthermia (LD-WBH) 40°        over 8 h (05-09/2009)    -   20× locoregional radiofrequency hyperthermia to the abdomen        (13.56 Mhz) (05-09/2009)    -   2 month treatment with E. coli (colon) antigenic composition        (05-07/2009)    -   Orthomolecular medicine: high dose vitamin C infusions (0.5        g/kg/BW), high dose artichoke and sylimarin extracts (liver)

Epicrisis details:

-   -   We started treatment end of 5/2009.    -   04/2010: CT abdomen and tumour marker demonstrate complete        remission; good clinical condition, Karnofsky 100%

Patient #7:

50 y old female patient with inoperable pancreatic cancer, ICD10: C25.9,with the cancer infiltrating the large vessels; Sonographic and CTevidence suggested invasion into superior mesenteric vein. firstdiagnosed O₂/2009; histology undifferentiated adenocarcinoma of thepancreas, pT3, N1, M1 G3 with peritoneal carcinosis; she underwent localradiation and low dose Xeloda as radiation sensitizer; when she begantreatment at our clinic the cancer was still unresectable; Karnofsky100%.

Treatments over 2 month 06-07/2009: (E. coli SSI for 11 months)

-   -   1× autologous NDV-primed Dendritic cell therapy in combination        with:    -   1× long-duration moderate whole body hyperthermia 40° over 8 h        (7-10/2009)    -   4× moderate whole body hyperthermia 38.5°    -   15× locoregional radiofrequency hyperthermia to the abdomen        (13.56 Mhz) (06-07/2009)    -   11 months treatment with E. coli (colon) antigenic composition        (06/2009 until today, ongoing)    -   Orthomolecular medicine: thymus peptides i.m; medical mushroom        (reishi, cordyceps, shitake;) high dose vitamin C infusions (0.5        g/kg/BW), high dose proteolytic enzyme therapy (wobenzym        phlogenzym), cimetidine.

Epicrisis details:

-   -   We started treatment end of 6/2009.    -   05/2010: complete remission, NED; PET 02/2010 demonstrated no        glucose uptake; tumour marker normal CA19/9: 4; good clinical        condition, Karnofsky 100%

Other Embodiments

Although various embodiments of the invention are disclosed herein, manyadaptations and modifications may be made within the scope of theinvention in accordance with the common general knowledge of thoseskilled in this art. Such modifications include the substitution ofknown equivalents for any aspect of the invention in order to achievethe same result in substantially the same way. Numeric ranges areinclusive of the numbers defining the range. In the specification, theword “comprising” is used as an open-ended term, substantiallyequivalent to the phrase “including, but not limited to”, and the word“comprises” has a corresponding meaning. Citation of references hereinshall not be construed as an admission that such references are priorart to the present invention. All publications are incorporated hereinby reference as if each individual publication were specifically andindividually indicated to be incorporated by reference herein and asthough fully set forth herein. The invention includes all embodimentsand variations substantially as hereinbefore described and withreference to the examples and drawings.

1.-29. (canceled)
 30. A method for treating a human patient for a cancersituated in the pancreas or in pancreatic tissue, the method comprising:administering to the patient a medicament comprising an effective amountof an antigenic composition comprising antigenic determinants of amicrobial pathogen, wherein the microbial pathogen is Escherichia coli(E. coli), and wherein the human patient has been diagnosed as having acancer situated in the pancreas or in pancreatic tissue.
 31. The methodaccording to claim 30, wherein the method comprises administering themedicament in successive doses given at a dosage interval of between onehour and one month, over a dosage duration of at least two weeks. 32.The method according to claim 31, wherein the method comprisesadministering the medicament in a dose so that each dose is effective tocause a localized inflammatory immune response at an administrationsite.
 33. The method according to claim 32, wherein the method comprisesadministering the medicament in a manner such that visible localizedinflammation at the administration site occurs within 1 to 48 hours. 34.The method according to claim 30, wherein the method further comprisesadministering to the patient an effective amount of an anti-inflammatoryagent.
 35. The method according to claim 34, wherein theanti-inflammatory agent is an NSAID.
 36. The method of claim 30, whereinthe patient is a patient that has been diagnosed as having suffered froma prior pathogenic exposure to the microbial pathogen.
 37. The method ofclaim 30, wherein the antigenic composition comprises whole killed E.coli.
 38. The method of claim 30, wherein the antigenic compositioncomprises antigenic determinants of only one microbial pathogen.
 39. Themethod of claim 30, wherein the E. coli is the sole active agent in thecomposition.
 40. The method of claim 39, wherein the E. coli is the soleantigen in the composition.
 41. The method of claim 30, wherein theadministering comprising administering the medicament orally,intradermally, or subcutaneously.
 42. The method of claim 32, theadministering comprising administering the medicament intradermally orsubcutaneously.
 43. A method for selecting an antigenic composition andtreating a human patient for a cancer situated in the pancreas or inpancreatic tissue, the method comprising: diagnosing the patient ashaving a cancer situated in the pancreas or in pancreatic tissue;selecting an antigenic composition comprising antigenic determinants ofa microbial pathogen, wherein the microbial pathogen is E. coli; and,administering the antigenic composition to the patient to elicit animmune reaction to treat the cancer.
 44. The method of claim 43, whereinthe method comprises administering the antigenic composition bysubcutaneous injection, intradermal injection or oral administration.45. The method of claim 44, wherein the method comprises administeringthe antigenic composition by subcutaneous or intradermal injection toproduce a localized skin immune response at a site of administration.46. The method according to claim 45, wherein the method comprisesadministering the antigenic composition so that visible localizedinflammation at the administration site occurs within 1 to 48 hours. 47.The method of claim 43, wherein the antigenic composition compriseswhole killed E. coli.
 48. The method of claim 43, wherein the E. coli isthe sole active agent in the composition.
 49. The method of claim 50,wherein the E. coli is the sole antigen in the composition.